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Home My WebLink About4-26-022 Paid by CEMETERY Receipt No.... .......Dated .....Jan 4 ��.... ' .....1997 ......... NO. List Price $ .................. Maximum No. Burial Spaces Lot 1,'2,3 .............. Block 26 Net Paid $ 1500.00 Monument permitted ... Unit 4 � ;) i) .................. (Data above this line for City Record only) / j�� iii#g of #rhaafian (�Pritrtrr J 7r1PP� NO. THIS INDENTURE MADE This ........24th........ day of .January .................................. A. D., 1997..., between lite City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Ruth. B., Wagner , and/or, Phyllis, Beatty .......................................... P.O. Box 1044 ........................................Roseland, ..FL .. 32958................................................................. . of the County of ........Indian River ........ . . . . . . . . . . . an -I State of , Florida...... _ . . as Grantee, WITNESSETHs 1500.00 That the Grantor for and in consideration of the sum of $ .............. to it �iVand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee "e1 r. , heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: Allof Lot(s)1 } 2 t 3 ,Block, 26 . , UNIT .. 4 ......... , 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. Lucia 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 iuch 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. CITY OF SEBASTIAN, FLORIDA Attest �.�.... By �......... ,...... �Ity, Clerk �... Mayor Signed, Sealed and Delivered In the resence oil 2/[ 2 .... ................. (Olitg deal) �FILORID ........... STATE COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ... 24th..............day of .January......,,,............................... 19.97, before me personally appeared Louise R. Cartwright and M. O'Halloran ................................................................................... 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 executed the foregoing conveyance to Ruth B. Wagner andfor,l?hyllis,Beatty ................ . ...........................I....................... and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorised; and that the Official seal of said corporation Is duly afflxpd'thereto, and the said conveyance is the act and deed of said corporation.` WITNESS ,oy signature and official seal at Sebastian, In the Co;Inty o�dl4111als'.)t, ofFloyida, ►ne day end yea.- lasl aforesaid. lPI / LINDA M. GALLEY MY COMMISSION / CC 976724 .. .................... . EXPIRES: June 10, 1998 Notr P c, Sta o lorida it BMW Unit Nattily Pubao lstdaarMMa My c Iadon ex t ' Linda M. Ga ley �3 13 lMrACjg� State oda, Department of Health, Vital Statistics • APPLICATION FOR BURIAL — TRANSIT PERMIT °Y A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF Ronald Hite Beatty DEATHFebruary 3, 1999 2. Place of Death City, Town or Location Name of (if neither, give street address) County HosBrevaInst. ores Brevard Melbourne Regional Medical Center Inst. 3. Name of Medical Medical Examiner Address Phone Number Certifier 1421 Malabar Road NE #245 Tarik Khair-El-Din M.D. Physician Palm Bay, FL 32907 (407)722-844 4. Name of Funeral Home/ ,Adays Palmetto Avenue Fla. Lic. No./Reg. No. Phone Number (Area Code) Direct Disposer I UE. Brownlie-Maxwell Funeral Hone Melbourne, FL 32901 0000049 (407)723-2345 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b IN Called Dr. Khair's office was contacted on 2/4/99 within 72 hours after death. He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that He will complete and sign the medical certification of cause of death. c ❑ was contacted on . He/she verified that Medical Examiner, will complete and sign the medical certification. 6. Place of Sebastian Cemetery In state tery/ Removal Final Disposition: Sebastian, FL crem - nam /bunty: from state Donation 7 Funeral Director/ Si We j F.E. No./Reg. ate Signed February 4, 1999 1049 Direct Disposer B. BURIAL — TRANSIT PERMIT Permit No. 499C49 Permission is hereby granted to dispose of this body. A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filing the deat e74r� Registrar or Date 2/4/99 Date Certificate Subregistrar Signature Issued: Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA Signature Medical Examiner Date or 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 Sebastian Cemetery Methods of Disposition: Place of Disposition Sebastian, FL XZ BURIAL ❑ STORAGE Date of Disposition ej ❑ CREMATION ❑ OTHER (Specify) Signature of ) or Person-in-ChargCharg e) - This permit must be endorsed by the Secton 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. DH 326, 10/96 (Replaces HRS Form 326 which may be used) (Stock Number: 5740-000-0326-2) f Name Unit_ Block Lot aG- Date of Mark -out ;2 /7 / 9 9 Date of Burial ��P / Time - 0 %q - n -i= J