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HomeMy WebLinkAbout4-24-16Chi LI of #pfittfi#tttn No. 0.1$9 THIS INDENTURE MADE Tbls ..... 28TH MARCH W1 2002 day of .............. ............................... A. D., , between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .................. ............................... GAIL.. DUNMYER .. .... . 1536 S. OCEAN DRIVE ................. ............................... VERO• . BEACH.,.. T-1 ORI.DA..32. 963 .......... ............................... of the County of .... INDIAN . RZ UR .................... ani State of ....... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ .A.'.9.00.. 00 .. , , . , , , , , . , 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 ... , , , , .. heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) .1.5 aJ � Block, . Z.4. . , , , 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 dried 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 lust above written. Attest:`.. ............ . Clty Clerk and ...1�... `............. ................. STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By .. .� .. IV -9. . "V . `!`" .............. Mayor ((Qitg Seal) I HEREBY CERTIFY, That on this .......... 2.Hth ... I ... day of ........ March .... ..............................I V..2002 before me personally appeared .....Walter W. Barnes and Sally A. Maio ................ 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 Gail r Dunmye ................................. ............................... ......................... ............................... 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 act and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and Year last aforesaid. H. JOANNE SANQBERG % . ti%U... ................. MY COMMISSION # CC 725842 Note, ublie, State of Florida at Large. . EXPIRES: April 30, 2002 My lesion expires r � b F Bonded Thru Notary Pubk Underwr0ers Name Unit Block Lot Date of Mark -out -- 79VO-2,- Date of Burial_ © Time Name of Funeral Home _/F Authorized by -T CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name, ❑ Cash Date 7 '/ JCheck # Amount Pal 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 fill I Community Center Rent U') Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 0) 601010 343800 Cl) + Lot/Niche / Block Unit 001501 369400 Interment Fee �c7 74t 001501 369400 Weekend Service 680800 220681 Yacht Club Security Deposit �a J Q 680800 220683 Riverview Park Security Deposit V t `V I 1 m O ¢ O o ti O r� O a L O M O. IL C) 0 N LL W3 C% 4 Q cA WR m� O m LL J Zv �> o. Cr z $a a= m¢ Cr CO) 1 O O III = II� o z II� 0 W cc xw apo O CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name, ❑ Cash Date 7 '/ JCheck # Amount Pal 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC /Code of Ordinances 001501 362100 Community Center Rent 001501 362100 Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots 601010 343800 Cemetery Lots + Lot/Niche / Block Unit 001501 369400 Interment Fee �c7 74t 001501 369400 Weekend Service 680800 220681 Yacht Club Security Deposit 680800 220682 Community Center Security Deposit 680800 220683 Riverview Park Security Deposit Total Paid Initials White - Dept. of Origin • Yellow - Finance a Pink - Applicant FLORIDA DEPARTMENT OF HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT Cl 1. Name of First Middle Last Date Month Day Year Deceased of Donald Ellis Dunm er Death 3/26/02 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. Sebastian 3. Name of Medical Address Phone Number Certifier Brian J. Deonarine, M.D, 923 37th Place Medical Examiner X Physician Vero Beach FL 32960 (772) 562 -9923 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 916 17th Street Strunk Funeral Home Vero Beach FL 32960 0130 772 562-2325 5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ® Cecilia was contacted on 3/26/02 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Deonarine will complete and sign the medical certification of cause of death within 72 hours. c. E was contacted on . He /she verified that , Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director / f Sig tur F.E. No. /Reg. No. Date Signed Direct Disposer J %" /.��,�/_.: �zr –=�_ 4690 3/28/02 B. ' BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 0130 -02 -0152 F-�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 fo filing the death certificate has b en r nested. !`Registrar or —� Date Date Certificate Subregistrar Signature ssued: 3/28/02 Due: 4/03/02 C. 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. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition 6,1516A:5 Z h/ ❑ BURIAL STORAGE Date of Disposition ' CREMATION OTHER (Specify) Signature Sexton 1,- or Person -in - Charge � , ,G/ t�r- 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. DH 326, 8/97 (Obsoletes all previous editions) (Stock Number: 5740- 000 - 0326 -2) Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar