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Xrutrtitrg 19Prb NO. 7�d�
97
THIS INDENTURE MADE Tile ....19th day of September A. D, 19......,
between the City of Sebastian, a municipal corporation existing under the lawsof the State of Florida, an Grantor and
John J. Grover
..................... I ................ 343 - Concord • Avelm................................................................. .
Sebastian, Florida 32958
.....................................................................................................................................
Indian River Florida
ofthe County of ............................................. and State of .......................................................
as Grantee, WITNESSETHt
That the Grantor for and in consideration of the sum of $ 2 5 ............... to itip hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee h1S , , , heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to -wit:
31 32, 34, 35, 36
Valf Lot(.) , .... , . , Block, ,?� .... , UNIT . 4, ... , ... , . , of Sebastian municipal cemetery as per Plat Number I 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 deed 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 seal to be hereto affixed, the day and year first above written.
l4
..
At /.y•%•./ .....
City Clerk
Sign - . Sealed said Delivered
In 'e Presence oft
/..... .Gr'................
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBABTIAN, FLORIDA
By .:•vau, .W.1.M. .............
Mayor
(0tg jqeal)
I HEREBY CERTIFY, That on this ........... 19th ....... day of .............aep.tw1t)..er .........................
before ttre personally appenred Walter W. Barnes Kathryn M. O'Halloran
............................I.........I........... and .. known
respectively Mayor still City Clerk of the City of Sebastian, a municipal corporation under the lax•a of the Stnte of Flor{de to me known
to be the Individunls land officers described In and who executed the foregoing conveyance to
............................................. John .J,., , Grover...............................:.....................................
............ „ .......................................... and severally acknowledged the execution titer t9 -be -their free act and deed
as such officers thereunto duly authorisedl and that the Official seal of sal corporation is duly affixed 1 eto, an11 the said conveyance
is the nct and deed of said corporation. / /
WITNESS any signature and official said at Sebastian, in the Cou ty of nd it It ver ate of Florida, h day and year
Iasi aforesaid.
LINDA M. GALLEY
Pms's t WI�MMISSM / CC 375724I9tPIREg:J.18,low _ oto ry Alia
State of orid a at Large.
am" Tia "my Palms tl adder Yrs My coven slon explr t
Linda M. Galley
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
StatWorida, Department of Health, Vital Stas
APPLICATION FOR BURIAL - TRANSIT PERMIT "/
1. Name of
First - Middle
Last
- -. -
Date
Month Day Year
Deceased
of
John Joseph
Grover
Death
August 4, 1999
2. Place of Death
City, Town or Location
Name of (If neither, give street address)
County
Hosp. or
Brevard
Melbourne
Inst. Holmes
Regional Medical Center
3. Name of Medical
Address
Phone Number
Certifier Frederick
Hobin, M.D. M. E
2500
S. 35th Street
X Medical
Examiner Physician
Fort
Pierce, FI
561-464-7378
4. Name of Funeral Home/Direct Disposal
Address
Fla. Lic. No./Reg. No.
Phone No. (Area Code)
Establishment
1623 N. Central Avenue
Strunk Funeral Home
Sebastian,
FI 11
1228
561-589-1000
5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. was contacted on
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that 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
med' I certification o caus of death within 72 hours.
6. Funeral Director/f ature F.E. No./Reg. No. Date Signed
Diroct� �/ - 8/4/99
B
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-99-0375
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.
F1 No extension of time for filing the death certificate has been requested. ---
Qae^ - Date Date Certifi ate
Subregistrar Signature C�--�+c Issued: Due: ) L
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.
Method of Disposition:
IN]BURIAL
CREMATION
Signature of Sexton 1
or Person -in -Charge J)
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
STORAGE Date of Disposition
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, 8197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number 5740-000-0326-2) Pink: Local Registrar
Name lei✓ J,-
Unit
Block 7
Lot Al
Date of Mark -out V/ ° ^` / t ,, •.ryry
Date of Burial el 71q 9. Time 42