HomeMy WebLinkAbout4-23-34f~iig of £-rbas#ittn b18~7
(~PIItP#~x1J ~PP~ N~.
THIS INDENTURE IMiADE T1+L .......~.f1.~tl........ day of .......ILl~..y ................................ A. D.,7~1~ • •~Of~l
between llu City of 3ebastlan, a municipal corporation ezlating under the laws'of the State of Florida, ea Grantor and
.............................................. Helen Far~;ugg~;Q.. .........................................................
120 Melton Avenue
.............................................. S~ebastian,...Elor.ida..3.29 58.............................................
of the County of ...Indian, River ..................... aul State of .....k'.a.~?xlda...... ...... ....................
se Grantee, WITNESSETH:
That the Grantor for and in consideration of the sum of $ . ~•, t 0 ~ ~ • ~ 0 ............ to it in hand paid, the receipt whereof is herewith ao-
knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , . , , , , , , , heirs, legal repre~ntatives and ensigns
the following property situated in Sebastian, Indian River County, Florida, to wit:
All of Lot(s) 3 3 & ~r G', Block, . 2 3 ... ,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. Lucia 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•usad ~lely 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 raguiations,~ordinancea and resolutions of the City of Sebastian, Florida, hereto-
fore, now and hereafter adopted or provided for the govm~nment 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.
1N 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 Brat above written.
Attest: ... .... ~ ..'. ~~ ~ ............... .
. ... City Clerk
Signed, Sealed and Delivered
in/the Presence oP: / ~
S ATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA
Mayor
lQ~t'tj ~p~~
I HEREBY CERTIFY, That on this .... ~:~.~kl .............day of ......... +Jlll.y ....................... ........, ~~ • .x+001
before me personally appeared .... w3~; tS'.~.. ri s.. ~~XII.(:,~ ......................... . and ..ria~.1.3T..A.• • rQ83:0...............
respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State oY Florida to me known
to be ti:e individuals and officers described in end who executed the foregoing cuaveynnce to
~/ n~,~- ~ / ~/Q
Name ~` /~~ L~~~~ r~~ ~~~ f `l4~`/~ ~
Unit
Block
Lot
Date of Mark-out
Date of Burial ~ ~ ~~ _ Time ~ ~ ' ~ ~` -
~, ~
Name of Funeral Home ~~~~~
Authorized by
J1.1L' 1"1,L~
A.
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
/~
~ o~~
1. Name of First Middle Last Date Month Day Year
Deceased of
Albert Farruggio Deatn July 13 2001
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst. Sebastian River Medical Center
3. Name of Medical Address Phone Number
certifier Edgar Blecker, M.D. 10596 U.S. #1
Medical Examiner Physician Sebastian, FL 561-581-0016
4. Name of Funeral Home/Di~ee!-Btapt7Sal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N . Central Ave.
Strunk Funeral Home Sebastian FL 1228 561-589-1000
5. Check
Appropriate
Box
6. Funeral Director/
B.
a. U The medical cert~cation has been completed and signed. A completed certificate of death accompanies this
application.
b.
c.
Patricia was contacted on 7 / 16./ 01
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Blacker will complete and sign the medical
certification of cause of death within 72 hours.
was contacted on He/she verified that
Medical Examiner, will complete and sign the
medical rt cat'on of ca e o ath within 72 hours.
~/' Si re ~, F.E. No./Reg. No. Date Signed
BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 122 $-01-0365
A five (5) day extension of time for filing the death cert~cate (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 cert~cate within
72 hours.
~No extension of time for filing the death certificate has been requested.
'!l9gl5tf'n-e/r Date Date Cert~cate
Subregistrar Signature ~~~,~.,L~,~A,,, ~ ~~ Issued: "1 ~ 3 O ~ Due: "'~' / ~, 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.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian C~e+metery
BURIAL STORAGE Date of Disposition - 7~ $ /~ of
CREMATION OTHER (Specify)
Signature of Sexton
or Person-in-Charge Y
This permit must be endorsed by the Sexton orperson-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.
Distribution: White: Cemetery w Crematory
DH 326, 8187 (Obsobtes all previous editions) Yelkfw: Funeral Dkec;tor or Dked Disposer
(Stock Number. 5740.000.0326-2) Pirdc: Load Rapistar