HomeMy WebLinkAbout4-21-09--- THIV of i�rhastiatt
NO.
THIS INDENTURE MADE Tlds ... 1St .............. day of .. S PtP# P- K............................. A. D., W..20100
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
DorothyChristie ....................... ...............................
502 Barefoot Blvd.
..................................... .......... ........ ...............................
of the County of .... Bre. vaxd ............................ and State of ..F.1. 0x7. da.......... ...............................
as Grantee, WITNESSETH:
That the Grantor for and in consideration of the sum of $ 1, $ 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) . 9.& 19 , Block, .. 21.. , 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 sane 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 debd 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.
AtteaaL.r.
Si ed, Se led and Dep
I the P ncee of-
- . __ eta TiT
City Clerk
c...... ............. .
CITY OF SEBASTIAN, FLORIDA
By ..Vll.�l� .4�+.1�!'t.�'!�...........
Mayor
(Cite oSeal)
--t.. ... ............... I v ..2000
Name
Unit_,
Block
Lot
Date of Mark -out I I I i
Date of Burial q Time / d
Name of Funeral Home S ul Ks-
Authorized by
CHRISTIE, DOROTHY
502 BAREFOOT BLVD.
BAREFOOT BAY, FLORIDA 32976
LOTS 9 & 10
BL OCK21
UNIT 4
Charles R. Christie interred 9/6/200 Lot 9
Paid by CEMETERY Receipt No ................. Dated ...9/1 12000 . _ ... , .. .
List Price $ . , , , , , Maximum No. Burial Spaces .................
Net Paid $ 1, 8QQ ;K ..... Monument permitted .......................
(Data above this line for City Record only)
Dorothy Christie
Lots 9 &10, Block 21, Unit 4
NO.
FLORIDA DEPARTMENT OF f/
HEALT Sta oLICATION FOR BURIAL HTaRANSIT Vital
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Charles R. Christie Death Aug. 31 2000
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 Noor Merchant, M.D. 13060 U.S. #1
Medical Examiner Physician Sebastian., FL 561- 589 -0879
4. Name of Funeral Home / Direct- Disposal•: 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 certificate of death accompanies this
Appropriate application.
Box
6. Funeral Director/
B.
b• �] Jeannie was contacted on 8/31/00
He /she verged 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
of �e of death within 72 hours.
F.E. No. /Reg. No.
1862
BURIAL - TRANSIT PERMIT
He /she verified that
Medical Examiner, will complete and sign the
Date Signed
8/31/00
Permission is hereby granted to dispose of this body. Permit No. 1228 -00 -0416
❑ 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;74./*%
Subregistrar Signature - `'A� Issued: 81/31/ca Due:
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 Sebastian Cemetery
BURIAL FISTORAGE Date of Disposition ,ice a
t
CREMATION OTHER (Specify)
Signature of Sexton
or Person -in- Charge
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, 6/97 (Obsoletes all previous editions) Distribution: White: Cemetery or Crematory Yet ow: Funeral
(Stock Number: 5740-000. 0326 -2) Pink:: Local Registrar r or Direct Disposer