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Home My WebLink About4-26-369 ; Paid by CEMETERY Receipt No .... Dated ......6/26/97.......... Lots 36 NO. Block [.v List Price $ 1 t �.:�....... Maximum No. Burial Spaces ................ Uhit4 .15�$Net Paid S . 1,000 . ......oo ......... Monument permitted ....................... (Data above this line for City Record only) (Mg of �rbtttttittn �rutrtitr jj 0PPb NO. THIS INDENTURE MADE This .....2nd ............ day of..........J�?............................... A. D, between like City of Sebastian, a municipal corporation existing under the laws or the State of Florida, as Grantor and Lillian Nicolace ............................................... 429 -Mel-ruse . Um ................................................................ Sebastian, Florida 32958 ..................................................................................................................................... of the County orIndian .RiVP.T ................ saJ State of .....i•,4Qri da.............. ............ .......................... as Grantee, WITNESSETH, That the Grantor for and in consideration of the sum of $ 1 t :9 ............... to it in hand paid, the mesipt whereof is herewith ao• knowledged, does by this instrument grant, bargaiiy 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)35. A. 36Bbdc.......... UNIT 26........ 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 novo lying and being in Indian River County, Florida. To Have and to Hold the same forever; provided that said property dull 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 sold cemetery. The conditions, restrictions and requirements contained In this Instrument shallbe 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 rubs, regulations, resolutions and ordinances and the condkioas of the dead of conveyance thereof then the title of such owner in and to said property shall terminate and the ams shall revert to the City of Sebastian, Fknlds. 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 Clark Signed, Scaled and Delivered in the Presence oft .�c�.......... ... .............. CITY OF SEBASTIAN, FLORIDA By •V •T 0,&. wtwllr:`f::.......... Mayor Wit A9121), STATE OF FT ORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this .... ...............day of.................J�.'............................1 lg 97, before nm personally appeared ... r. Walter W. Bernee and K8t11L. y.n. 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 ..................................................i111M.nqQ14lCe.............................................................. ........... 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 affixed thereto, and the said conveyance Is the act and deed.of said corporation. WITNESS my signature and official seal at Sebastian, In the Con ty of ! and �te of 1►loA;1 ynthe day and year last aforesaid. r A i! / I InCO111WBggrtxg7 . i asMTlaa�PrMollidaraNaa 13111m, AM Nota Public, Statef a at Lrge. MyInion expireEt L M. Gallev Name--P��i Unit Block Lot_ Date of Mark -out r /97 Date of Burial Time Name of Funeral Home Authorized State of Florida, Departt of Health and Rehabilitative Services, Vital tistics APPLIC FOR BURIAL — TRANSIT PERMIT a-'/ A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF Orazio E. Nicolace DEATH May 30, 1997 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. Sebastian River Medical Center 3. Name of Medical Certifier Thomas A. Jackson, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Home 5. Medical Examiner 777 37th St. Address 1623 North Sebastian, Address Phone Vero Beach, FI 32960 561-569-2710 Fla. Lic. No./Reg. No.1 Phone Number (Area Code) Central Ave. FI 32958 1228 561-589-1000 Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b ❑ Leann was contacted on 6/2/97 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 Dr- Jackson 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 Cemet In state ceme r Removal Final Disposition: crematory ;e/county: Indian River from state Donation 7. Funeral Director/Sig ur F.E. No./Reg. No. Date Signed 1862 6/2/97 B. BURIAL — TRANSIT PERMIT 1228-97-0259 Permission is hereby granted to dispose of this body. Permit No. ❑ 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. �. A Date Date Ce r 'fi t Subregistrar Signature • �' �'' /' Issued: S Due: 9 r% C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA Signature or , Medical Examiner 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. D. CEMETERY OR CREMATORY Methods of Disposition: Place of Dispositiondrn e M BURIAL ❑ STORAGE Date of Disposition 0",gz .21, / 029 ❑ 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) (Stock Number: 5740-000-0326-2)