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Home My WebLink About4-26-32TitV of #Phan ian r m i t r r G iG NO. THIS INDENTURE MADE T1als ...26 ................ day of...,'....MarCYl............................. A. D., 1897..., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Nancy Johnson ..................................................' P.O. ' 'Btsx• 9 25 ................................................................. • Roseland, Florida 32957 ..................................................................................................................................... of the County of ... Tndian.River Florida ............................. an] State of ................................................. as Grantee, WITNESSETHs l , That the Grantor for and in consideration of the sum of $ M. DO ............... 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 ,her heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 31 A. !;lock, . , ?6 , . , , 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 runping 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 dried 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 fust 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. F � Dlwaj&: .... -..... , . City Clerk Signed, Scaled and Delivered /theresence of: 11 l� .............. ............................ CITY OF SEBASTIAN, FLORIDA B,? .L�.a,°......:.... . Mayor (Titer �$enl) STATE OF FLORIDA COUNTY OF INDIAN RIVER 26th March 97 I HEREBY CERTIFY, That on this ........................day of .................................................... 18...., before n:e personally appeared .Walter W. Barnesand Kathryrl M...0.i.Halloran ....... ......... respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the individuals and officers described In and who executed the foregoing conveyance to .................................................. Nancy..JQbn$o>:I................................................................. ........................................................ and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorized; and that the Official seal of said corporation is duly affixe ereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the last aforesaid. �,�V r LINDA M. GALLEY MY COMMISSION N IX; 376724 EXPIRES: June til, IM 4` Bonded nm NotRY POW Oncbmftm of Florida, the day and year lr. . ✓. ?cam .r. ... . ..................... Nota Public, State lorlda at I.a ge. My c mrnission ex : Linda M. Gall y 3. Name of Medical Medical Examiner Address Phone Number Certifier 13840 U.S.#1 Ralph Geiger, M.D. X Physician Sebastian Florida 32958 (561)388-0770 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 Kathy was contacted on 03,491,497 - 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 _Ralph Geiger, 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 certifi tion. 6. Place of Sebast i an Cemetery In ate�metery/ Removal Final Disposition: cr ry - nam /c Indian River from state Donation 7. Funeral Director/ i ure F.E. No./Reg. No. Date Signed isposerIL� 47- M/91 /47 B. BURIAL — TRANSIT PERMIT Permit No. 1228-97-0133 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. R� Date Date Cert Subregistrar Signature '`�� Issued: 3 ZC g Due: .3 � S 9 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-�-�-e2 54 BURIAL ❑ STORAGE Date of Disposition + e_h a r, 19 `� 7 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in -Charge ) 11. �.. a w.• e - 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) �! ?7, - State of Florida, Depart of Health and Rehabilitative Services, Vit tistics �j APPLICATION FOR BURIAL - TRANSIT PERMIT L� A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Steven Johnson DEATH 03/20/97 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. 12385 Roseland Road 3. Name of Medical Medical Examiner Address Phone Number Certifier 13840 U.S.#1 Ralph Geiger, M.D. X Physician Sebastian Florida 32958 (561)388-0770 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 Kathy was contacted on 03,491,497 - 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 _Ralph Geiger, 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 certifi tion. 6. Place of Sebast i an Cemetery In ate�metery/ Removal Final Disposition: cr ry - nam /c Indian River from state Donation 7. Funeral Director/ i ure F.E. No./Reg. No. Date Signed isposerIL� 47- M/91 /47 B. BURIAL — TRANSIT PERMIT Permit No. 1228-97-0133 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. R� Date Date Cert Subregistrar Signature '`�� Issued: 3 ZC g Due: .3 � S 9 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-�-�-e2 54 BURIAL ❑ STORAGE Date of Disposition + e_h a r, 19 `� 7 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in -Charge ) 11. �.. a w.• e - 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) Name 4571 Unit I/ BlockG Lot Date of Mark -outer r /512 Date of Burial_ ' S` ! % Time -` oo a r� Name of Funero Homey kuth'erized