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NO. 15
14th'November 96
THIS INDENTURE MADE Tkla ...................... day of ............................................. A. D., 18......,
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
Franklin & Donna Savage
.......................................... .2.22''Ca'coa S'tnei.t.. S.Te........................................................
...........................................Palm Bay, Florida 32909..................................................
of the County of ........................ an] State of ........ F'IQrid.$...................................
as Grantee, WITNESSETHt
That the Grantor for and in consideration of the sum of $ ..... 1 .9. 00.•.0 .... 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 the l r , heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to -wit:
All of Lot(s) 3 6 & 3 7, Block, ... 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 inch 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 shalt 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 fust above written.
Attes�� ... f.!.�:.�� ..... ........
City Clerk
Signed, Scaled and Delivered
I the Presence of:
r
.. ................
S ATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA
By mac. c.<.,a.A,.....)� :.. .
Mayor
(Civ "Seal)
I HEREBY CERTIFY, That on this ............. 14th ...........day of..........November........................................., 1P1.1
before me personally appeared ,,,LOuise R. Cartwright. ....... ... and Kathryn M.....0.'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
.............................................Fxaxxklia ..&..Ronna ..Savage..................................................
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 thereto, and the said conveyance
is the fret and deed of said corporation. �/1
FLORIDA DEPARTMENT OF
HEALT
k. (TYPE)
I. Name of
Deceased
State of Florida, Department of Health, Vital Statistic
APPLICATION FOR BURIAL - TRANSIT PERMIT
%06 -
First Middle Last Date t Year
of
Franklin Delano Savage Death August 2 2004
L Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Bay Panama City Inst. Bay Medical Center
3. Name of Medical Azzam Adhal, M.D. Address Phone Number
Certifier 2195 Jenks Ave, Suite B
Medical Examiner PiPhysician Panama City, FL 32405 784-6696
t. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 100 E. 19th Street
3outherland Family Funeral HM Panama City, FL 32405 1478 1(850) 785-8532
i. Check a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. E]
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. M was contacted on
medical certification o cause
i. Funeral Director/ Signature
Direct Disposer Joseph D.McLendon
3. BURIAL
rs.
F.E. No./Reg. No.
------FE- 4214
PERMIT
He/she verified that
Medical Examiner, will complete and sign the
Date Signed
26, 2004
Permission is hereby granted to dispose of this body. V Permit No. 1-04-194
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.
Registrar or Date Date Certificate
Subregistrar Signature .tag± Issued: Aug. 26, 2004 Due: Aug. 30, 2004
Tit -7
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, Sebastian, FL
nX BURIAL STORAGE Date of Disposition Z-6)
CREMATION
Signature of Sexton 1
or Person -in -Charge !}
OTHER (Specify)
rhis 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
)H 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
Stock Number: 5740-OOD-0326-2) Pink: Local Registrar
tZi
Q
v
v
Name
R9r4kLsN S/?Vq 0 P, 10� N�
Unit 1
Block C�- 5'
Lot 3
Date of Mark -out
Date of Burial Y Time
Name of Fune
Authorized by