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Home My WebLink About4-26-40Paid by CEMETERY Receipt No...9. ....... Dated ...January 29 , 19 9 7 List Price S .................. Maximum No. Burial Spaces ................. Net Paid $ ..3600 00..... Monument permitted ....................... (Data above this line for City Record only) fait! of Or.bos#ian Lot ../,38,39,40' Block 26 Unit 4 (11j l%' (SP1ttrtPrIj 0PPb NO. 29th January 97 THIS INDENTURE MADE TW ...................... day of ............................................. A. De 19....... between the City of Sebastian, ■ municipal corporation existing under the laws of the State of Florida, as Grantor and ........................................................................ 8440 U.S. 1 ............................................... Kicco.,..BL.... 329.7.6 ............. ............................................ of the County of ...Inds$n.11n.r..................... ani State of .Florida......................................... as Grantee, WITNESSETHr That the Grantor for and in consideration of the sum of $ , 3 600 : 00 .... to it I,hand paid, the receipt whereof is herewith so- knowledged, does by this instrument grant, bargain, sell, release, convey and conium unto the Grantee ;',e j =, hairs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All.( Lot(s) A7.% 3 A(&, Aq . 2 6UNTf . , 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 Clark 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 bold the same forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shill 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 shallbo covenants running with the land. In the event of the failure of the owner of any property situated within add cemetery to ob- serve and comply with ouch rules, regulations, resolutions and ordinances and the conditions of the dead of conveyance thereof then the title of such owner in and to taid property shall terminate and the same alba 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 i Attest: �C� [�!!!C....... By t <441.<,O�{.�...I.E.0 City Clerk `` Mayor Signed, Sealed and Delivered (In the Presence oft .td�.w....s:...CQr.4......................... STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ....2.9.th.............day of..JanuAry ..................................... 1997. before me personally appeared „ Louise R. Cartwright and Kathryn M. O'Halloran respectively Mayor and City Clerk of'the City of Sebastian, a municipal corporation under the lawn of the State of Florida to me known to be the individuals and officers described in and who executed the fort -going conveyance to .................................Bonnie. E..ap.41or. Charles. A...Douglas.......................................... ........................................................ 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 Bald corporation. WITNESS my signature and official seal at Sebastian, In the Ccty +rd# to of Florida, the day and year lest aforesaid. I (J J n/1 UNIIA M. WUIEY w elilltMsW 9 M SM24r /-iiollan .....................EMM Jas 1l,1909 Not 4 Public, St at MyAmomisslon ex#Leal Linda M. Galley Unit Block Lot Date of Mark-out— Date I of Burial Time Name of Funeral Home– Authorized by State of Florida, Departm of Health and Rehabilitative Services, Vital istics / 3 7- ��✓ �3 APPLICA FOR BURIAL —TRANSIT PERMIT A. (Type or Print) / 1. Name of First Middle Last DATE Month Day Year Deceased Charles A. Douglas DEOF ATH 01/27/97 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Palm Bay Inst. Palm Bay Medical Center 3. Name of Medical Certifier John Jessup, M.D. Medical Examiner Address 1400 Pine Street Physician Melbourne, Florida 32901 (407)676-6000 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 Phone Number 5. Check Appro- priate Box a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies this application. b C Jodi was contacted on 01 /28/97 within 72 hours after death. He/she verified that this d h w s from natur causes, that there was no accident nor other external cause of death, and that John Jessup, H. will complete and sign the medical certification of cause of death. was contacted on . He/she verified that , Medical Examiner, will complete and sign the medical certification. 6• Place of a as i eme ery In state cemetery/ Removal Final Disposition: cremat ry - name/co nty: Indian River from state Donation 7. Funeral Director/ Signat -/}/) F.E. `)./Re�No. Date Signed �� c u . ,c 01/28/97 B. BURIA 7eTRANSIT PERMIT Permit No. 1228-97-0057 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 deajh certificate requested. Date Date Cerci i ;e Subregistrar Signature —,- <�.L.�,�C.[ Issued: % 7 9 Due: 9 7 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 Seha cti an r emetery BURIAL ❑ STORAGE Date of Disposition Jan" ry 31,199:7 ❑ 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) „J