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Tr ut r t r r y Be it b NO.
THIS INDENTURE MADE nle ....... 5.th.......... day of ........ June A. D.,y1K.2QP1
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
.... ............................... Edward J. Regan .. ..... ... ...........
6155 S. Mirror Lake Dr., No. 105 " "
..... ............................... Sebastian., ..Florida.. 3295B........................ ...............................
of the County of .......Indian River Florida
an] State of ........................ ...............................
as Grantee, WITNESSETHe
That the Grantor for and in consideration of the sum of $ % 5 0 • 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.. , Block, ,2 � ..... 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 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.
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 first above written.
Attest: . .
... ........
City Clerk
Signed, Sealed and Delivered
In the Presence of:
0 .........
ST TE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA
By •WJEJ).. �.WVC�.."" ..................
Mayor
(aam �sexl)
I HEREBY CERTIFY, That on this ........5th ...........day of ......J. tun e. ........... ............................Ity ..Z
before me personally appeared ......Wajter..W...Ba.rnes Sall A. Maio
and .........3t.... ....................
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
..................... .......................Edward. J .. Regan.................................. ...............................
........................................................ 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 SANDBERG
r... ......
...........
Y COMMISSION A CC 725842 Nota ublic, State of Florida at La e.
EXPIRES: April 30,20W My lesion expires:
Bonded Thru Notary Public Underwriters
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FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
� as
�y
1. Name of First
Middle
Last
Date
Month Day Year
Deceased
of
Claire
Marie
Regan
Death
June 2 2001
2. Place of Death City, Town or Location
Name of (If neither, give street address)
County
Hosp. or
Indian River
Sebastian
Inst. 6155 S. Mirror
Lake Drive, #105
3. Name of Medical
Address
Phone Number
Certifier Syed Zaidi, M.D.
14110 U.S. #1
MMedical Examiner rtlPhysician
Sebastian, FL
561- 589 -3755
4. Name of Funeral Home /90eeHBiepa9M
Address
Fla. Lic. No. /Reg. No.
Phone No. (Area Code)
Establishment
1623 N.
Central Avenue
1
Strunk Funeral Home
Sebastian, FL
1228
561- 589 -1000
5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. Rehan was contacted on 6/4/01
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Zaidi 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 ' I c4rtifiion of c se eath within 72 hours.
6. Funeral Director/ ture F.E. No. /Reg. No. Date Signed
862 6/3/01
B.
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228 -01 -0282
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.
Registtare n Date Date Certificate
Subregistrar Signature Issued: (p 1 Z l 6 Due: (a b l Q'
C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA
19
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 od of hours after death is
required for all cremations.
Method of Disposition:
u BURIAL
CREMATION
Signature of Sexton 1
or Person -in- Charge J
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
STORAGE Date of Disposition U
OTHER (Specify)
y
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.
Distribution: White: Cemetery or Crematory
DH 326, 8197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740-0011-0326 -2) Pink: Local Registrar
nPIt -RA, hDWARD J . DEED 41796
6155 S. MIRROR LAKE DR. NO. 105
SEBASTIAN, FLORIDA 32958
LOT 15, BLOCK 22, UNIT 4
CLAIR B. REGAN INTERRED 6/6/01
(Data above this line for City Record only)
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Paid by CEMETERY
Edward
J'
Re
Regan
List Price$,75Q.OpC..........Q78*6.
..Dated....Q5.
/.p1.,
....
L o t
15
Block
Net Paid $ 5 Q : 0
Maximum N 0.
Burial Spaces
........
...
22�
Uni 4
T
NO.
Monument Permitted ...
,
(Data above this line for City Record only)
MY of
SX
HOME OF PELICAN ISLAND
June 11, 2001
Edward J. Regan
6155 S. Mirror Lake Dr., No. 105
Sebastian, Florida 32958
Dear Mr. Regan:
Enclosed is Cemetery Deed number 1796 for Cemetery Lot 15, Block 22, Unit 4
A copy of the receipt is enclosed for your records.
If you have any questions, please contact our office.
Sin ely
e
Sal y As," o., C
City Clerk
SAM/js
Enclosures
The Sebastian Cemetery
City of Sebastian, Florida
Receipt is acknowledged in the sum of.
Dollars ($ 75 D - DD )
From:
on this day of 20e for the purchase of the following
described Cemetery Lots) e(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot(s)/Niche(s) Block „? Unit
Purchase Price: Dollars ($ 7S0, Z)D )
Terms and Condition of Sale:
This contract shall be binding upon both parties, the seller and the purchaser, when approved
by the owner of the property above described:
I, or we, agree to purchase the above described property on the terms and conditions stated in
the foregoing instrument:
Purchaser signature
Purchaser signature
The City of Sebastian agrees to sell the above mentioned property to the above named
purchaser(s) on the terms and conditions stated in the above instrument.
,-City of Sebastian Witness