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Home My WebLink About4-23-36f~i#~ of ~pbrtt~#ittn ~~1~~:~; C~P##tP~P~'~ ~P~~ N~- THIS INDENTURE MADE ThL ......lZ~h...:..... day of :........ Jul-.y ............................. A. D.,~..~r.Q41 between i!-e Clty of Sebastiaty a municipai corporation ezlating under the laws'of the State of Florida, ae Grantor and ...................... ................J~u~.e>~.E:...Q1= ..Tune.~.J.a..Hasse,r.t.............................................. 1732 Sunrise Lane ........................................ Sebas ti•an,...F~or•i~da• •32.9 5 8 .............. ................................. o! the County of ...Indian, • R?:Ver ..................... and State of ......}~' ~-.QX1,S~$..................................... sa Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of S 1 ~.QQQ s QQ ............. to it in hand paid, the mceipt whereof is herewith ac knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , , , , , , , , , heirs, legal mpresentatives and assigns the following property situated in Sebastian, Indian River County, Florida, to~vit: All of Lot(s) 3 ~ &~'~ ,Block, , z 3. , , , ,UNIT , , , ,~}. , , , , , , , , of Sebastian municipal cemetery as par Plat Number 1 themof mcorded in Plat Book 2, at page 65 of the public mcords in the offlcs 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 fomver; 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 msolutioas of the City of Sebastian, Florida, hemto- 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. ]n the event of the failum of the owner of any property situated within said cemetery to ob- serve and comply with such rules, mgulationa, msolutions and ordinances and the conditions of the debd of conveyancx 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 sad year first above written. CITY OF SEBASTIAN, FLORIDA Attes ... ..~: ~~~~ ................. . City Clerk igrted, sled and Delivered in th ence of•. /,/y~~ ~~ p ~~ c... ........ ........ ....... ..~... ........... TATS OF FLORIDA COUNTY OF INDIAN RIVER By .V.:! ~~:~-~ . ~~ .............. . 1Kayor ((1litg ~fex!) I HEREBY CERTIFY, That on this .....~.,2~Y1............day of .........2111X ......................... ........, ~ac..2~~1 before me personally appeared .......~'~1.$.~•~e)=..W.....~1xx1G.S ........................ and ..Spa.1~.~.A...Ma.].A.............. respeetIvely Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me k.,.+,.... to be the individuals and officers described in and who executed the forrQOinR CUPVEVnnew +~ L 3 ~ -.. F7.,p~R1M ~NT OF ~ p~ 3 HEALT HTaRANSIT PERMITics S~ ~ APP (CATION FOR BURIAL A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased James Edward Hassert of Death Juiy 24 2001 2. Place of Death City, Town or Location Name of (If neither, give street address) County Indian River Roseland Hosp. or Inst. Sebastian River Medical Center Name of Medical 3 Address Phone Number . Certifier Noor Merchant M.D. 13060 U.S. #1 FL Sebastian 561-589-0879 Medical Examiner Physician , 4. Name of Funeral HomelDi+ast~Diopaa~ll Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastia n FL 1228 561-589-1000 5. Check a. ~ The medical certification has been completed and signed. A completed certificate of aeatn accompanies >ms Appropriate application. Box b ~ Paula was contacted on 7 / 2 4 / 01 Helshe verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Merchant 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 i I cert~i ion use of death within 72 hours. 6. Funeral Director/ Si u F.E. No./Reg. No. Date Signed ~ ~ 1862 7/24/01 B BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit Na 1228-01-0381 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. ~~ Date Date Cert~ to Subregistrar Signature M ~~ Issued: '? ~ ~ Due: ~, ~, AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date Medical Examiner, ,gave authorization by telephone to Funeral DirectorlDirect 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 BURIAL STORAGE Date of Disposition .~'~ CREMATION OTHER (Specify) Signature of Sexton orPerson-in-Charge } w .A. 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. Distrd~ul'an: White: Cemetery or Crematory DH 326, 8197 (Obeoletes all previous editions) Yelbvr. Funeral D~sdor or D'rect Disposer (Stock Number: 5740.000-0326-2) Pink Local Regafrsr ~,..r~e , Name ~i4M ~ C ,~,. Unit~_ Block._ Lot ~~ Date of Mark-out *' Date of Burial ~~ "~ / ~. Time, ' Name of Funeral Home_~'r,~ Ii ~/ ~ ~~+ ,.'; J ~` Authorized by ~ ~ : .- ;: ~.. . .- ~r... .,E