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Home My WebLink About4-26-22° Paid by CEMETERY Receipt No....: List Price $ .................. Net Paid $ .15.00...00 ....... January 23, 1997 .......Dated .............................. Lots 2i,..1 Maximum No. Burial Spaces ................ Mock 26 Unit 4 Monument permitted ....................... (Data above this line for City Record only) NO. r'1j6J (9ifg ofrhtt�tittn �'YJf�J Trittettrry Bprb NO. THIS INDENTURE MADE Tho .....23rd........... day ofja?try.................................. A. D., 1o.97.:., between Ilse City or Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .......................................... Joseph Simon ......... . .......................................................... 6304 River Run Drive ............................................. ... Sebaetian,..FL ...32958....................................................... . of the county of ... Indian River Florida ................................... and State of ....................................................... as Grantee, WITNESSETHt That the Grantor for and in consideration of the sum of s .1500. 00 ................ to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee ... he ... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: Ali of Lot(s) .U.22 , Block, . 26. . . . , UNIT ... k ........ , 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 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 19 Attest: I1:.�.ti.r....... By . ........ ... '......... City Clerk May Signet], Scaled and Delivered In th Presence of: ?G9ui....... .................. (41ii4 j9enl) STATE OF FLORIDA COUNTY OF INDIAN RIVER I IIEREBY CERTIFY, That on this ....23ra..............day of ... sT44144U ...................................... 1997., heroes one personally appeared , . Louise R. Cartwright Kathryn M. O'Halloran .................... and ................. I..................... respectively Mayor and City Clerk of the City of Sebastian, a muhiciti pal corporation under the laws of the State of Florida to me known to be Line individuals and officers described In and who executed the foregoing couveyance to .............................................. Joseph... Simon..................................................................... . .................................................. I..... and severalty acknowledged the execution thereof to be their free act and deed ns such officers thereunto duty authorisedl and that the Official seal of said corporation Is duly affixed thereto, and the said conveyance is the net and deed of said corporation. WITNESS my signature and official seal at Sebastian, In the Cou y of len r and ate f Florida, the day and year Inst aforesaid. i LIND=BALLEY t1Y CAMMiG MRFots Public, State o F ride at Large =WW TinaMy c mtoUalon expires Linda M. Galley / ,2 State of Florida, Departt of Health and Rehabilitative Services, Vita�tistics PLIC APN FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Karen J. Si monD OF TH 01/01/97 2. Place of Death County Indian River 3. Name of Medical Certifier City, Town or Location Vero Beach Charles Fischman, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes 5 Check Appro- priate Box MI Medical Examiner Name of (If neither, give street address) Hosp. or Inst. Indian River Memorial H( Address ital Phone Number 1600 36th Street Physician Vero Beach, Florida 32960 (561)569-6112 Address I Fla. Lic. No./Reg. No.1 Phone Number (Area Code) 1623 North Central Avenue P.A. Sebastian, F1 32958 1228 (407)562-2325 The medical certification has been completed and signed. A completed certificate of death accompanies this application. b 13t Carl y was contacted onn1 /n/nq/47 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 Charles Fischman, 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 Cemetery In state cemetery/ Removal Final Disposition: cr atory - nam unty: Indian Ri ver from state Donation 7. Funeral Director/ nature F.E. No./Reg. No. Date Signed Direct Disposer bftvg I a 4. 2 n1 /n3/97 B. BURIAL — TRANSIT PERMIT Permit No. 1228-97-0003 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 filin the death certificate requested. Aegistfef-OF- Date' /� /9' Date Certific tg Subregistrar Signature � Issued: Due: / (./.97 /97 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 CR BURIAL ❑ STORAGE Date of Disposition _. ra mtia rrr5' l 99 7 - l ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in -Charge ) 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) iStock Number: 5740-000-0326-2) cJj Name- T 43 <-,4) 'i ron rp Unit Block Lot Date of Mark -out.- I - 3- Date of Burial J7 - '(/� � Name of Funeral V Authorized Koine Time