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Home My WebLink About4-23-30„~ (~i#g of ~~~tts#ittn 4:i81`~ ~ ~ NO. . THIS INDENTURE >rdADE ThL . ~kX,YI .........:..... day of ......Q~~Q~?~X.:......................... A. D.,~ . 2QQ1 between ilse Clty of Sebastian, a municipal cerporat[on existing under the laws of the State of Florida, as Grantor and ........................................... HARRY..~I... AND ..JUAKITA..D.~~RZC.K.......................................... 206 COBIA CT. ........................................... BAREFOQT . BAY,.. ELO.R.IDA .329 7.6-25 5.8................................... of the County of .......Indian,.Riyer ........ ........ snl State of ........Florida....,.,,_.......,....._.....,,.... u Grantee, WITNE99ETH: That the Grantor for and in cenaideration of the sum of S . ?. a s2e ~ Q r.Q ~ ............ to it in head paid, the receipt whereof is herewith so- 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) 2s9 ~i'~:0, Block, , ,~r~ , , , ,UNIT .... ~{ ....... , of Sebastian municipal oamatery as per Plat Number 1 thereof recorded in Plat Book 2, at page 65 of the public rewrda in the office of the Clerk of the Circuit Court of St. Ludo 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•uaed solely and exclusively for the interment of the human dead and shall be used, kept and maintained at all times in axordance with the rules and regulationa,~ ordhnances and resolutions of the City of Sebastian, Florida, hereto- fore, noov and hereafter adopted or provided for the government and operation of said cemetery. The conditions, matrictions and requirements contained is this instrument shall be coveffints running with the land. In the everd of the failure of the owner of any property situated within said cemetery to ob- serve and comply with §nch 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 thin 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. Attests ~-~. ........................ the and CITY OF 3EI3A8TIAN, FLORIDA Mayor '. Fl ...r..... ~ .....• ....... STATE OF FLORIDA COUNTY OF INDIAN RIVER (Qlttq o$Eal) I HEREBY CERTIFY, That oa this .....4th ,,,,,,,,,,,,,agy or .......October .............................. ~..Z001 ., before me personally appeared ......W81.t('L",, W.,.,Barnes ......................... and .....Sally .A.,, Msio ........... respectively Mayor and City Clerk of the City of Sebastian, a municinal Cornnrnt•tnn nnrlw. +1.. town ns ts,_ sa._._ -~ --• -- ~. ,._ - - i Unit Block ~_,1 Lot _ ~ ~ ' Date of Mark-out_ ~~ f~ fl Date of Burial ~~~ j Time ~ O ~ Name of Funeral Home • • ~ .~ ~ ~ ~ ~` x Authorized by -~-~-.. ~~'"• ~. ^ a Paid by CEMETERY Receipt No... 0 0 6 6.. , • .. , ,Dated .....1 ~ ~ 4 ~ O l List Price S..~r.s2~~r~Q... .............. Maximum No. Burial Spaces ...... . Net Paid $ ..?,,~ 2 5 0.00 ......... . • ... Monument permitted ...................... . DETRICK, HARRY W. & JUANITY LOTS 29,30 BLOCK 23, UNIT ~. ~ ~'~' (Data above this line for City Record only) ITY OF SEBASTUN 0 2 9 7 cmr ci.ERfcs t~FICE RECEIPT NamR~~~/~~:. iii /.G'~..d~"~/~.2. ~0 C-ashes Date __!~ ! f o~ d'/~ L ~ AmowrtPaM 001oo12oeool 001501 322900 001501 341920 '' 001501 341910 001501 362100 001501362100 001501 362150 '! 001501 343800 601010 343800 001501 369400 001501 369400 ~' 680800220681 680600220662 'I 680800220683 I I Sales Tax Garage Sales CapieslBid Specs. LDC1Code of Ordinances Communiiy Center Rent Yacht Club Rent Non Taxable Rent Cemetery Lots Cemetery Lots LotMiche .Block , 41nit _ Interment Fee ¢ Weekend Service Yacht Club Security Deposit Community Center Security Deposit RIV@NIeW Park Security Deposd r ~~ ~,-dr- ToW Pald ^~ ~ ~L Initials Whits - Oapt. of Origin • yellow - Finance • Pink • Applicant FIARIDA DEPARTMENT OF HEALT State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of Juanita Cleopatra Detrick Deatn Dec. 9 2001 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Melbourne Inst. Carneige Gardens Nursing Center 3. Name of Medical Address Phone Number certifier Joseph Hurlbut M.D. 720 E. New Haven Avenue FL Melbourne 321-724-4545 Medical Examiner Physician , 4. Name of Funeral Home/ osal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Avenue Strunk Funeral Home Sebastian, FL 1228 561-589-1000 5. Check a. ~ The medical certification has been completed and signed. A completed certltlcate of oeatn accompanies tms Appropriate application. Box 12/10/01 b. ~ Donnie 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 Dr. Hurlbut 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 me ' cert~ do cause of death within 72 hours. 6. Funeral Director/ Si atu F.E. No./Reg. No. Date Signed Di~s!•9tsooset~ 8 62 12 / 10 / O 1 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-01-0584 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 cert~cation of cause-of-death section of the death certificate within 72 hours. ~No extension of time for filing the death certificate has been requested. Date Date Certificate Subregistrar Signature Issued: / ~. J' ~O / Due: I ~.// yl~O / 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. Awaiting period of 48 hours after death is required for all cremations. p. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery ~i BURIAL STORAGE Date of Disposition ~/ D y CREMATION Signature of Sexton 1 or Person-in-Charge J} OTHER (Specify) This permit must be endorsed by the Sexton or within 10 days to the local County Health Depai DH 326, 8/97 (Obso~tes all previous editions) (Block Number: 5740.000-0326-2) t-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned in the county where disposition occurred. Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar