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Home My WebLink About4-20-28Tttu of OrhasttMri G il` i NO. THIS INDENTURE MADE Tlals ...... 1Qth.......... day of ......JA 01Ja1r.y ........................... A. D.,Xc..2P.Q1 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Louis R. Palle 1112 Breezyway ....... ......................S.ebas.t- inn,.. Flor.lda .. 329 5. 8............................... ............................... . of the County of ... lRdiAR ..RiYe.37 ..................... and State of ..... F a. ida...................................... as Grantee, WITNESSETHt That the Grantor for and in consideration of the sum of $ 5 Q Q A Q ................. 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) . 2R.. , Block, . 2Q... , UNIT L{ ......... , 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 lust above written. Attest: ........... City Clerk Sidned, Se ed and Deli e Ifi the encG a ot--. . Cam,. ................ CITY OF SEBASTIAN, FLORIDA By VV. ..Y.V.. IMIi.� ................. Mayor ((dity 'Setrl) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ........10th.........day of .... .JanuarX ................................... W..4001 before me personally appeared ... Wa1ter..W... Barnes... and . .. o , 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 Louis R. Palle ............................................. .......................................................................................... ......................... ............................... 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. =�yr'Fi H. JOANNE SANDBER(3 i� - - IF. .- MY COMMISSION f CC 725842 Not. ublle, State of Florida at La �- EXPIRES: April 30,2M2 My co Isslon expires: • ' Bonded Thru Not" Public Underwriters Name //"oU/ S Unit Block Lot Date of Mark -outs Date of Burial Time r - Name of Funeral Home AJ Authorized by J. PALLE, LOUIS R. v20�'� DEED #1770 1112 BREEZYWAY SEBASTIAN, FLORIDA 32958 LOT 28, BLOCK 20 UNIT 4 LOUIS R. PALLE INTERRED 1/5/01 Paid by CEMETERY Receipt No ................. Dated ...1/ List Price $ ..5 00 : 00 . Maximum No. Burial Spaces ............ . Net Paid $ .. Q Q, Q Q.... .. Monument permitted ...................... . (Data above this line for City Record only) Louis R. Palle NO. Lot 28, Block 20, Uni Z • LL. 0 P co J9 i f z LL t CO 79 cm .& z I.- i 1 -V 9 = a FLORIDA DEPARTMENT OF HEALT Tin" Aof Florida, Department of Health, VitaNktistics 3 a D APPLICATION FOR BURIAL - TRANSIT PERMIT Z/ �/ 1. Name of First Middle Last Date Month Day Year Deceased Louis Richard Palle of Death Jan. 1 2001 2. Place of Death City, Town or Location Name of (If neither, give street address) County Indian River Sebastian Hosp. or Inst. 1112 Breezyway, ltnit, 1 -F 3. Name of Medical Address 2500 S. 35th Street Phone Number Certifier harles A. Diggs, M.D., .M. E. Fort Pierce, FL 1- 561 - 464 -7378 Medical Examiner Physician 4. Name of Funeral Home / pWRl Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) 1623 N. Central Ave. Establishment 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 b Lydia was contacted on 1/2/01 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Diggs will complete and sign the medical certification of cause of death within 72 hours. C. was contacted on He /she verged that Medical Examiner, will complete and sign the medi rtifica ' h goduse of death within 72 hours. 6. Funeral Director/ �rya4ur F.E. No./Reg. . No. 1/2/01 ed Quest N9lN"ff B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -01 -0004 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. error Date Date Ce Cate Subregistrar Signature /'"&* Issued: j I O t Due: rti G b/ 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 STORAGE Date of Disposition 2,0r, CREMATION FJOTHER (Specify) Signature of Sexton 1 or Person -in- Charge J} 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 smr OF ;1E !imN ROME OF PELICAN ISLAND January 12, 2001 Louis R. Palle 1112 Breezyway Sebastian, Florida 32958 Dear Mr. Palle: Enclosed is Cemetery Deed number 1770 for Lot 28, Block 20, Unit 4 Also enclosed is a form - Return for Transfers of Interest in Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court, when and if you have the deed recorded. A copy of the receipt is enclosed for your records. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, 2000 16th Avenue, Vero Beach, Florida 32960. nce y, .. ally A. P 0 , CMC City Cler SAM /j s Enclosures Ile Sebastian Cemetgy City of Sebastian, Florida Receipt is acknowledged in the sum of: a. 04 111,19 on this /D day of 20,�Z_ for the purchase of the following described Cemetery Lots iche(s) on the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)/Niche(s) Block ol-0 Unit Purchase Price: Dollars.($ 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. ity of Sebastian Witness