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Home My WebLink About4-21-16i AM Tttu of #PI1aSfiiltt It Ut rtrrlj W'i i NO. (}1Y60 THIS INDENTURE MADE nb .....Z1St........... day of ...... September ....................... A. 13,,Xlk.Z9 0 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Frank E. or Dorothy. I., ..Osborn ............................ . .7.09..Silverhorn..C.t.: .................................... Barefoot..Bax.,...T Orlda..32. 976................... ............................... of the County of ....... Indi.an..Rime = ................. and State of ........ Florida.... ............................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ .l a. 8.0 Q t 0 0 ............. 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) 15.&16 , Block, . 2 L ... , 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, and Delivered In the resepce of: .)g ......•.� s ..................... ... 1Q0 ......... STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By Ily- Ate.......... Mayor (Cite deal) I HEREBY CERTIFY, That on this ....... 21St .......... day of ..... ► S. ep tml?. er ............................... iv before me personally appeared ..Waltar...W.,..$ erne .S ............................. and .Kathryn..M,...Q'.H 11Q.raA. 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 .... .............. ..I .................. Frank.. �...Qx..l1.QXot. X.. ►.. QSb4. XA............. ............................... ......................... ............................... 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 d year last aforesaid. H. JOANNE SMIDBERG ./ 6 ' ` N ,� MY COMMISSION # CC 725842 Notary ubBe, State of Flor4&r .� EXPIRES: April 30, 2002 My co ' fission expires: Bonded Thru Notary Pubk Underwriters Name Unit Block Lot Date of Mark-out Date of Burial J Time Name of Funeral Home Authorized by FLORIDA DEPARTMENT OF HEALT /TVDG\ State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Da y Year Deceased of FRANK EARL OSBORN Death November 18, 003 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Inst. Atlantic Health Care Indian River Vero Beach 3. Name of Medical Address Phone Number Gary R. Silverman, M.D 777 37th Street, Suite D103 Certifier Vero Beach, Florida 32960 772 - 770 -0500 Medical Examiner x Physician 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 6026 North US Highway 1 Aycock Funeral Home Fort Pierce, Florida 34946 2210 772 - 461 -8912 5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Danielle was contacted on 11/18/03 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Silverman 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 edical certif tion of cause of death within 72 hours. 6. Funeral Director/ F.E. No. /Reg. No. Date §igned j Direct Disposer 5� ///5 G B. BURIAL - TRANSIT PERMIT C. Permission is hereby g 'ed to dispose of this body. Permit No. 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. MX No extension of time for filing the death certificate has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: ' l Due: Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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 d2 x❑BURIAL STORAGE Date of Disposition Il A CREMATION Signature of Sexton or Person -in- Charge OTHER (Specify) 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, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number 5740 - 000 - 0326 -2) Pink: Local Registrar