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HomeMy WebLinkAbout4-26-20Paid by CEMETERY Receipt No.. 3 r ....... Dated, February A2, 1997 No. List Price $ .................. Maximum No. Burial Spaces ................. Lots L9,20 1000.00 Block 26 Net Paid $ .................. Monument permitted ....................... Unit 4 (Data above this line for City Record only) (/ 17/ 7- 6 - fang of #rhaaf att Trutrtrry Bert NO. THIS INDENTURE MADE TWr .12..th.............. day of ..Fe.b.roarY ............................ A. D., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and William Thornton ......................................................1098 • Tosver••Raad..................................................... Sebastian, FL 32958 ..................................................................................................................................... of the county of ...,Indian.,River,,,,,,,,,,,,,,,,,,,,, and state of ..Florida. ........................................... as Grantee, WITNESSETHn That the Grantor for and in consideration of the sum of $ 1., .0..0.0 ' 00 . to it hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , , ,13... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) , 19 , 2%I ck, 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. 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 inch 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 Attests .. •.��•r•,[..1�/ •.��L';�!.... By ��-ld.GrGrL!..... ....... ..... �-!,...... (J City Clerk Ma, yO Signed, Scaled and Delivered In the rest oti ,/ �r s/CeL ... ................. (�Tit�t ,geaQ STATE OF FLORIDA COUNTY OF INDIAN RIVER 7 I HEREBY CERTIFY, That on this ...1 2.t1?..............day of..'ebtuary..................................... 19.9.f beture me personally appeared .Louise R. Cartwright and Kathryn M. O'Halloran ..................................................... ...............................I..... 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 individuuls and officers described In and who execuNd the foregoing conveyance to William Thornton ............................ ..................................................................................... and severally acknowledges) the execution thereof to be their tree act and deed as such officers thereunto duly authorized; and that the Official acid u[ acid corporation Ir duly af( thereto, and the said conveyance is the net and deed of said corporation. WITNESS my signature and official real at Sebastian, in thepnty RI an�� �ot F�rida, the day end year last aforesaid. UNDA M. oAlu Y , Mty catttlgallxt d cc �s�x� ... .. . F)WIREti Jur til, tYBs Nota Public, t e of larlda�-" rge. ���y^Aa�y,r My ommisrlon pireu Linda M. Galley © State of Florida, Departm*FOR of Health and Rehabilitative Services, Vital tistics ✓�� _� APPLICA BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Richard Allen Sikes OF 02/05/97 DEATH 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Fellsmere Inst. 68 N. Myrtle Street 3. Name of Medical Medical Examiner Address Phone Number Certifier 5305 Babcock Street N.E. Kyle Anderson, M.D. Physician Palm Bay, Florida 12905 (561)676-9009 4. Name of Funeral Home/ Address Fla. Lic. No./Reg. No. Phone Number (Area Code) Direct Disposer 1623 North Central Avenue Strunk Funeral Homes, P.A. Sebastian, F1 32958 1228 (407)562-2325 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b ® Melinda was contacted on n9 /r)6/97 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 Kyle Anderson, M. D. 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 Cemete In state cemet Removal Final Disposition: cremator -,e/county: Indian River from state Donation 7• Funeral Director/ Sign re F.E. No./Reg. No. Date Signed QifflPWN@"W /(/a_ II&Z 09/nR/g7 B. BURIAL — TRANSIT PERMIT Permit No. 1228-97-0071 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 death certificate requested. RegietrtDate �/9 Date Ce*ya 9 Subregistrar Signature %� Issued: ` 7 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 Methods of Disposition: Place of Disposition 1�LBURIAL ❑ STORAGE Date of Disposition ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in -Charge) ,da.b�u��L eQrx< 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) Stock Number: 5740-000-0326-2) J Name Unit Block Lot 1< 0 Date of Mark -out Date of Burial _ _ !j(! Time Name of Funeral Horn4 Authorized by; yam+ t ✓" Paid by CEMETERY Receipt No ... 9 3 2 ••••..... Dated. February 12, 7 List Price $ ... ..19 199 9 . Maximum No. B Net Paid $ ..1000. QQ ursal Spaces NO. . .. .... •• Lots 19,20 Monument permitted .. • • • • • • • • . Block 2 6 .........Unit 4 (Data above this line for City Record only)