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Home My WebLink About4-25-30Paid 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 Name Unit Lot Date of Mark -out Date of Burial Time State of Florida, Departf Health and Rehabilitative Services, Vitalstics APPLI( u FOR BURIAL — TRANSIT PERMIT Lf 1j/ A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF Chalmers Dean Medl ing DEATH 12/18/96 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. 21722 73rd Lane 3. Name of MedicalMedical Examiner Address Phone Number Certifier 2500 35th Street Frederick Hobin, M. D. M.E. Physician Fort Pierce Florida 34981 (561)464-7378 4. Name of Funeral Home/ Address Fla. Lic. No./Reg. No. Phone Number (Area Code) Direct Disposer 1623 North Central Avenu 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 ❑ was contacted on 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 will complete and sign the medical certification of cause of death. c Helen was contacted on 12/119/96 He/she verified that FreaericK Robin, M. U., M. Medical Examiner, will complete and sign the medical certification. 6. Place of Sebastian (;eme er In state ce et Removal Final Disposition: cremato - e/county: , Indian River from state Donation 7. Funeral Director/ Sign r F.E. No./Reg. No. Date Signed Bireel�lllr -we it R 4 %. 12/19/96 B. BURIAL — TRANSIT PERMIT 1228-96-0579 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 Min the death certificate requested. fivylsh al. Date Z f + 9 L Date Certificate Subregistrar Signature Issued: / I Due: 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 -1-c. ,-7-i i ,*,V,y ee/-7Ei 6Ri/ QBURIAL ❑ STORAGE Date of Disposition _b Ecek-b, 2 aC , 191` ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) orPerson -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) iStock Number: 5740-000-0326-2)