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Home My WebLink About4-25-29Paid by CEMETERY Receipt No ... 910...... Dated ..J?0WXY.23s .1997 ........ NO. Lots 0, 29, 30 List Price $ .................. Maximum No. Burial Spaces ................. Block 25 Net Pard S 2250.00 ........ Monument permitted ............ Unit 4 1,1564 x1j6,Q (Data above Wa line for City Record only) Tug of #rhaattun TrutPtery Derb NO. THIS INDENTURE MADE 761a .....23rd........... day of ..January ................................ A. D., 1997..., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ................ I............................. "'2T722"3'r ane Donna Medling ................................ ............................................... Vero ,Beach.r. .FL ....3296.6 ...................................................... of the County of ..Indian . River ......................... anal State of Florida ............................................ as Grantee, WITNESSETHr That the Grantor for and in consideration of the sum of $ .225Q•QQ................ 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 ..She.. , heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(40a.29s Aock, . 2.5 .... , 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 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 Attest: ' ' (..✓ .,,�F.f G!' t;�... By C�..�.......... .. City Clerk Mayor Signed, Sealed and Delivered in the resence oh (Titg �*cnl) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this .Prd..................day of Janl 17........................................., 19.97. before me personally appeared Louise, R., Cartwright .................... and Kathryn. 1! ...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 Donna Medling ....................................................................................................................................... ................................................. 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 affixed -1 ereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the Cognty o I d Iverrgyp State of Florida, th day and year lost aforesaid. __ /1/7 W tDMMISSM / CC 576721 G B(PI�S: Jur I5,19I9 r.... g .. ................ . BaidedThuNollryP�OtolMidraaMsta Nota Public, Sta of ride at Lar e. My co mIssionxjrf et Lin M. Gal ey 4-� Name Unit Block Lot Date of Mark -out �z Date of Burial Time Name of Funeral Home Authorized by C by to -'O t., :C24 c� ++ xi O y CIS W - d°�, y -bnoo s 4+ ~ w Gi x m o� .�,cCi eS S i . �'Cn O cz g.O - to O ty y� Ili _to � yi i V ,w co * i V 4' 86 ZEi� �C 4n C)4_2 6 ctS O, 0 y S3 y Lti' ' " U . xc,) O (� rn a).;tw U 0Afle° a�,�� o cxw. c�v� o o y�.y. Fi .ccs U .° ° p ;", .. tr1- : U ¢' ..:1-1 1�'ti a 6N3de 0�F Total Paid �d4 Initial: White — Dept. of Origin • Yellow — Finance • Pink - Applicant ®Security l d d o c u 21 1 at Se e - back 7 r deia i l a..® STRUNK FUNERAL HOMES, P.A. 4702 CASH ADVANCE. ACCOUNT -SEBASTIAN 916 17TH ST: VERO BEACH, FL 32960 1 A FLORIDA DEPARTMENT OF HEALT /TVDC\ J4' -LS - -Z� State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT C(0))D 1. Name of First Middle Last Date Month Dayll Year Deceased Donna Jean Medling of Death Aug. 16 2004 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or radian River Roseland Inst. Sebastian River Medical Center 3. Name of Medical Address Phone Number Certifier Farhat Khawaja, M.D. 7754 Bay Street Medical Examiner Physician Sebastian, FL 772-589-3000 4. Name of Funeral Home/BireetBispes Address Reg. No. Phone No. (Area Code) 1623 N. Central Ave.Strunk Establishment Sebastian, FL =1'228 772-589-1000 Funeral Home 5. Check a. The medical certification has been completed and signed. A completed -certificate of death accompanies this Appropriate application. Box b. Tina was contacted on 8/17/04 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Khawaja 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 rt' ca ' cause of death within 72 hours. 6. Funeral Director/ Si --,re F.E. No./Reg. No. Date Signed 9we&-Bnr&"r 1862 8 / 16 / 04 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-04-0328 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. F�No extension of time for filing the death certificate has been requested. %R@@i948F_,. Date Date Certificate Subregistrar Signature rL► Issued: 8/16/04 Due: 8/21/04 L Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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 Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition T — d-0 Q 4Z CREMATION OTHER (Specify) Signature of Sexton o Person -in -Char a 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 County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326, 8197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number 5740-000-0326-2) Pink: Local Registrar