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Home My WebLink About4-26-38Paid by CEMETERY Receipt No ..9. ....... Dated.. . January .2, 1997 .............. O Lot ../,38,39,4' List Price $ .................. Maximum No. Burial Spaces ................. Block 2 6 3600.00 Unit 4 Net Paid $ .................. Monument permitted ....................... (Data above this Use for City Record only) /��/" � 111 J / Tttg of Orba'attan TrutPfPrij Drrb NO. 29th January 97 THIS INDENTURE MADE Thls ...................... day of ............................................. A. D., 19....... between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ....................................Bwmn ,t.. ...Axxd./.ux.. .................................... 8440 U.S. 1 ............................................. ... M.icco.,.. KL.... 329.7.6.................. ....................................... of the County of...1ndi$n..Umr-.r..................... an•1 State of.Fl,Orida.......................................... as Grantee, WITNESSETHs That the Grantor for and in consideration of the sum of $.............. to it Iq hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee t e l r hero, legal representatives and assigns the following property at -a" in Sebastian, Indian River County, Florida, to -wit: Ali of Lot(s) 3 7Aj4% 40....? 6UNIT .. 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 SL 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 sdd 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 acid cemetery to ob- serve and comply with inch rules, regulations, resolutions and ordi ances and the conditions of the tided of conveyance thereof then the title of such owner in and to said property shad terminate and the same stall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The add party of the first part has caused this histrument to be executed in its name and on its behalf by its Mayor and attested by its City Clark and Its corporate said to be hereto affixed, the day and year first above written. CITY OF SEBASTIAN, FLORIDA Attest ,I .6!..... ByiGt c.t .`A1... %C..0 Clty Clerk ` Mayor Signed, Sealed and Delivered In the Presence oft .td�,c•c...:....C�4......................... STATE OF FLORIDA COUNTY OF INDIAN RIVER 1 HEREBY CERTIFY, That at thla ....2.9.th.............day of ..Januiary ..................................... 1997. before me personally appeared ., Louise R. Cartwright` and Kathryn M. O'Halloran ............................. respectively Mayor and City Clerk of'the City of Sebastian, a municilal corporation under the laws of the State of Florida to me known to be lite individuals and officers described in and who executed the forrgoing conveyance to .................................Bonnie.. E..ax>:d/.or, Charles. At..DouglaS.......................................... ........................................................ and severally acknowledged the execution thereof to be their free aid and deed as such officers thereunto duly authorisedi 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 Coynty o�tver 3 to of Florida, the day and year Inst aforesaid. I /1/1 YY COtgA18810N / Cc 916T24t .. ..X ...... ... ..................... EXP AN IL 1gggt--�`M'=;:u Florida at LargadM ilea Msbf Rile IYiasaMas t Linda M. Galley Lor 3a +� I so 'QLR-% t CA- 3� s( o s i CITY OF SEBASTIAN CITY CLERK'S OFFICE /, RECEIPT 4 Name Cash Dab heesk ff No. Amount Palo 001001200001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Cods of Ordkrances 001501341930 Election OualiM g Fees 601010 343800 Cemetery Lots Lot/Niche . Block . Unit 001501343805 Cemetery Fees tJY't�.1r� - Total Panty , o e9 Initial$ White — Dept. of Origin a Yellow — Finance • Pink • Applicant ®._' r> Unit BloCk Lot Date of Mark -out— / 1 Date of Burial5"��"' r Time _ Af . Kc V. �:') / L Name of Fune Authorized by FLORIDA DEPARTMENT OF HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased of Mandy Jo Douglas Feb. 29 2005 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Barefoot Bay Inst. 926 Wren Circle 3. Name of Medical 5a jid S. Qalser, M.D.1750 Address Phone Number Certifier Cedar Street Medical Examiner Physician Rockledge, FL 2955 321-633-1981 4. Name of Funeral Home/Oirect-Bi5158' I Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 32958 1228 772-589-1000 5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. was contacted on He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. C. was contacted on He/she verified that Medical Examiner, will complete and sign the medical cat' use of death within 72 hours. S. Funeral Director/ n F.E. No./Reg. No. Date Signed D;�eef� 1862 3/3/05 3. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-05-0089 A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. �No extension of time for filing the death certificate has been requested. RA94"erer Date Date Certificate Subregistrar Signature ! �, �A 0 -4 -4 -VU Issued: 2/24/05 Due: 2/28/05 - - -- -T AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: 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. �. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition A `p CREMATION OTHER (Specify) Signature of Sexton t or Person -in -Charge 1) -his 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 vithin 10 days to the local County Health Department in the county where disposition occurred. Distribution: white: Cemetery or Crematory rH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer Stock Number 5740-000-0326-2) Pink: Local Registrar