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Home My WebLink About4-25-34�a Paid by CEMETERY Receipt No.... r 7 ........ Dated .....8/.7./.9.6 ................ Lots* & 34 NO. 1,000.00 Bloc, _5 List Price $ ... i 0 00 -00..0 o ...... Maximum No. Burial Spaces .................Unit 4 -154 ®� 5 , ' Net Paid $ .................. Monument permitted ....................... � (Data above this line for City Record only) Ti#g of #r1jus#inn T.tG m e t h G r NO. Tills INDENTURE MADE Tkls .............t....I... day, . of ............... August . A. D., Ie. 96., ............................ between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .......................................... �a,lli.an..S.handl.ow................................................................ 709 Wimbrow Drive .......................................... Seba.s•tian•, • • Florida. 329-56 ..... ............................................ of the County of ..Indian.,River...................... ani State of Florida.......:. as Grantee, WITNESSETHr That the Grantor for and in consideration of the sum of $ ..1, OOO . go 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 , ,her. , heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: Au of Lot(s) , 3 3 & 34 Blew 2 5 UNIT ... 4 ........ , of Sebastian municipal cemetery as per Plat Number I thereof recorded in Plat Book 2, at page 6S 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 some 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 iuch rules, regulations, resolutions and ordinances and the conditions of the tided 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 Attests • �1�"'� • '.Y4/........ By ..... ... ..... I ..... ...... . ....... City Clerk Mayor Signed, ex 1 and Delivered ZOUNTY e os............. X.................. �• FLORIDA F INDIAN RIVER I IIERRBY CERTIFY, That on this ........... 7.th........ day of ................August........................, I9.96, and Kathryn M.. O'Halloran.• before me personally appeared...............Louise R. Cartwriht.................. �.... reaprc•tively Mayor and City Clerk of the City of Sebastian, x municipal corporation under the laws of the State of Florida to me known to be Ilse Individuals and officers described In and who exeeutcd the (ongoing conveynnce to ........................................... J iX.lAAn..$.hal•dl.ow............................................................... ........................................................ and severally acknowledged the execution thereof to be their free act and deed as site[, officers thereunto duly authorised; and that the Official seal of said corporation Is duly affixed thereto, and the said conveyance is the act load deed of said corporation. WITNESS my signature and official seat at Sebastian, in the Cour(Ity of I lay ser and a Florida rlfr day and year last aforesaid. 1 17) I MYCOMMISSION 00087Sf44 otxry u -/1-0 b it M(PIRES: Jugs 18,1888 q�aTMp"pa*�;y,s My cam Isola Linda M y...�.. .. ... ..... .-...:......... ................ State of FI Ida at Large. ey Name—, X,- p", Unit Block - Lot Date of Mark -out Date of Burial— Time Name of Funer4 I Home /5 Authoriied by State of Florida, Departm f Health and Rehabilitative Services, Vital ''stics �� s APPLI1 *FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF Ernest Shardlow, Jr. DEATH 08/02/96 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Palm Bay Inst. Palm Bay Community Hospital 3. Name of Medical Medical Examiner Address Phone Number Certifier 5305 Babcock Street N.E. Bhaskerrao Patel M.D. Physician Palm Bay, Florida 3 90(561)676-9009 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 122 (407)562-2,12S 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b [5j Karen 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 Rhaskprrao Patel M_n_ 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 Sebast i an Cem e y In state cem a Removal Final Disposition: X crema y me/county: Indian River from state F7Donation 7. Funeral Direc`�tor/ Sig t F.E. No./Reg. No. Date Signed �Ct Bi8ys� / -� 1 97r3 no In= /Ac B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-96-0357 ❑ 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. .12egistw sF., Date Date Certificate Subregistrar Signature Issued: Qto Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA M 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. Methods of Disposition: f BURIAL ❑ CREMATION Signature of Sexton ) or Person -in -Charge) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Date of Disposition 1:3 Z Z A?Jr +o 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)