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THIS INDENTURE MADE nW ...... 1.5.th......... day of .....Sept.ember........................ A. D., 199.7....,
between the City of Sebastian, a municipal corporation existing under the laws.bf the State of Florida, as Grantor and
Hazel Fitch and/or Charles Fitch
..................................................P0'' BO'X" 707.. .....................
..........................................
Roseland, Florida 32957
.....................................................................................................................................
of the County of..........1?4d�AA.UXPK.............. vial State of d
....Floria
..............................................
as Grantee, WITNESSETHs
That the Grantor for and in consideration of the sum of $ ......... to it ip handp aid, the receipt whereof Is herewith ac-
knowledged,
sknowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee tie 1 rheirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to -wit:
All of Lot(s)? 1 & 2 2 , Block, . , ,? , , , UNIT ..:......... , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded In Plat
Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being
in Indian River County, Florida.
To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shall
be used, kept and maintained at all times in accordance with the, rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto-
fore, now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, restrictions and requirements contained
in this instrument shall be covenants running with the land. In the event of the failure of the owner of any property situated within said cemetery to ob-
serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the dead of conveyance thereof then the title of such owner
in and to said property shall terminate and the same shall revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the first part has caused this instrument to be executed in its name and on its behalf by its Mayor and
attested by its City Clerk and Its corporate seat to be hereto affixed, the day and year first above written.
Attest, .11G� ...4
City Clerk
Signed, Scaled and Delivered
in t Presence of:
i.. ...................
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA
By W.. S.Ov.- l.'�.............
Mayor
15th September 97
I HEREBY CERTIFY, That on this ........................day of .................................................... 19....,
before me personally appeared ... Walter W. Barnes. M. Halloran. .
.............
and .. ....
respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known
to be the Individuals and officers described In and who executer) the foregoing conveyance to
Hazel Fitch and/or Charles Fitch
.......................................................................................................................................
........................................................ and severally acknowledged the execution thereof to be their free act and deed
as such officers thereunto duly authorised, and that the Official Saul of said corporation is duly affixed thereto, and the said conveyance
is the act and deed of said corporation.
WITNESS my signature and official seal at Sebastian, In the only of lan River Stat of Florida, the day and year
last aforesaid. /
my COMMON (f 8..�i�i ... / -- F.
�Y. ��G... W -.L.T .............. .
D9rIRE8: June 19, 1999 P bllq 9t f Florida at Large. Jar
Bo:M>odllsuNOWyRAAolhldsnahMs MY cotrua air expir s:
Linda M. Ga ley
Name
Unit '`,71
Block
Lot
Date of Mark -out
Date of Burial Time %+
Name of Funeral Home
Authorized by
f'
U -y A3- a7 ,-o7- zZ
"iixf
n D State of Florida, Department of Health, Vital Statistics lv/
APPLICATION FOR BURIAL - TRANSIT PERMIT
A_ (TYPEI
1. Name of First
Middle
Last
Date
Month Day Year
Deceased
of
Hazel
D.
Fitch
Death
Aug. 1 2001
2. Place of Death City, Town or Location
Name of (If neither, give street address)
County
Hosp. or
Brevard Palm Bay
Inst. Integrated Health Services of Palm Bay
3. Name of Medical
Address
Phone Number
Certifier Syed Zaidi, M.D.
14110 U.S. #1
Medical Examiner Physician
Sebastian, FL
561-589-3755
4. Name of Funeral Home/DirieeHNsposal
Address
Fla. Lic. No./Reg. No.
Phone No. (Area Code)
Establishment
1623 N.
Central Ave.
Strunk Funeral Home
Sebastian, FL
1228
561-589-1000
5. Check a. The medical certification has been completed and signed. A completea certtncate or aeatn accompanies tnls
Appropriate application.
Box
b. � Doreen was contacted on 8/2/01
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that D r . Za i d i will complete and sign the medical
certification of cause of death within 72 hours.
C. was contacted on He/she verified that
, Medical Examiner, will complete and sign the
medical certification of cause of death within 72 hours.
6. Funeral Director/ Signature F.E. No./Reg. No. Date Signed
Dre&0*ogW 3 915 8/2/01
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-01-0395
A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within
72 hours.
�No extension of time for filing the death certificate has been requested.
rmwsLrar Date Date Certificto
Subregistrar Signature Issued: g� l,» Due: D (e Q
C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA
Approval Number: Date
Medical Examiner, , gave authorization by telephone to
Funeral Director/Direct Disposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is
required for all cremations.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
BURIAL STORAGE Date of Disposition 8/ 4P1
CREMATION
Signature of Sexton 1
or Person -in -Charge Jr
OTHER (Specify)
This permit must be endorsed by the Sexton or person -in -charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned
within 10 days to the local County Health Department in the county where disposition occurred.
Distribution: White: Cemetery or Crematory
DH 326, 8/97 (Dbsoleles all previous editions) Pink:
Funeral Director or Direct Disposer
(Stock Number: 5740-000-0326-2) Pink: Local Registrar