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Home My WebLink About2-52-16(iifg of Orhasti. n P11tP�x ��l'�1 NO. 1051 THIS INDENTURE it[AD$ TWs .......15th .. , .... , day of May .... ............................... A. D., 1Y.85 ... between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .............. ank & Irene J: Fowler....................................................... ............................... 776 E. Wren Circle ............... �a�PQi:. �� ...�R�a...329S.s .............. , .............................. ............................... ofthe County of ...Indian River ........................ awl state of .....F1or....... .... ............................... as Grantee, WITNVMZTHi That the Grantor for and in consideration of the sum of $ , . , ,700 ti 00 „ , , . , . , , .. , , , to it in hand paid, the receipt whereof is herewith so- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , the i r _ heirs, logal representatives and assigns the foliawing property situated In Sebastian, Indian River County, Florida, to-wit: All of Lot(s) ,15 &1 f- Nbck, . 5 2 , ... UNIT , ?, ,a d d i t i one 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 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 tided 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. Attests �+GLAL /...'....... City Clerk Signed, Sealed and Delivered In the Presence oft .............. Nok, ........ CITY OF SEBASTIAN, FLORIDA Bc ........... ce — Mayoe STATE OF FLORIDA CO,VNTY OF INDIAN RIVED I HEREBY CERTIFY, 'Mat oo OW .....15 th .............day of .... M?y .............. ........................ , 11 5. , before me personally appeared ...La., Gene.:Harris.... 1. and Deborah Kr C.,.a9es ....., 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 ankl officers described In and who executed the foregoing conveyance to Frank & Irene J. Fowler ........................................................................................................ ............................... ......... ,.............................................. and severally acknowledged the execution thereof to be their free act and deed as sugb"ofticers thereunto duly authorisedi and that the Official sal of said corporation Is duly affixed thereto, and the said conveyance is �: art -#ad deed of saki corporation. Name Unit Block Lot Date of Mark -out 4? Date of Burial � 5-- 92 Time 00 A - hll Name of Fu Authorized Indic: 3. Name of Certifier Medical 935 Barefoot Number 4. Name of Funeral Home/ Address Fla. Lic. No. /Reg. No. Phone Number (Area Code) Direct Disposer 1623 North Central Avenue Strunk Funeral Homes P. A. Sebastian, 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b was contacted on of egg ono within 72 hours after death. He /she verified that this death was from natural causes, that there was no accident "'_' `.... I , Muhammad Siddi lli will complete ' nor other external cause of death, and that and sign the medical certification of cause of death. c ❑ was contacted on . He /she verified that , Medical Examiner, will complete and sign the medical certification. 6. Place of Sebastian Cemeter In state c t Removal Final Disposition: remat - e /county: Indian River from state Donation Sign re F.E. No. /Rey. -Ab. Date Signed 7. Funeral Director/ Li /%„ _ _ B BURIAL — TRANSIT PERMIT Permit No. 1228 -92 -0047 -- Permission is hereby granted to dispose of this body. ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director /Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filing Aie death certificate requested. Registrar or Date 2� (j Date Certificate Subregistrar Signature Issued: ! Due: l C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature Medical Examiner Date or 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 Methods of Disposition: 0 BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge) ❑ STORAGE ❑ OTHER (Specify) Place of Disposition t-71 ai < 7 An/ 69 . Date of Disposition � — g - 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740- 000 - 0326 -2) State of Florida, Department ealth and Rehabilitative Services, Vital Statistics Sat APPLICATION BURIAL — TRANSIT PERMIT u °2# A (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased I rene JoAnn Fowler OF DEATH 01/23/92 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Inst. Indic: 3. Name of Certifier Medical 935 Barefoot Number 4. Name of Funeral Home/ Address Fla. Lic. No. /Reg. No. Phone Number (Area Code) Direct Disposer 1623 North Central Avenue Strunk Funeral Homes P. A. Sebastian, 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b was contacted on of egg ono within 72 hours after death. He /she verified that this death was from natural causes, that there was no accident "'_' `.... I , Muhammad Siddi lli will complete ' nor other external cause of death, and that and sign the medical certification of cause of death. c ❑ was contacted on . He /she verified that , Medical Examiner, will complete and sign the medical certification. 6. Place of Sebastian Cemeter In state c t Removal Final Disposition: remat - e /county: Indian River from state Donation Sign re F.E. No. /Rey. -Ab. Date Signed 7. Funeral Director/ Li /%„ _ _ B BURIAL — TRANSIT PERMIT Permit No. 1228 -92 -0047 -- Permission is hereby granted to dispose of this body. ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director /Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filing Aie death certificate requested. Registrar or Date 2� (j Date Certificate Subregistrar Signature Issued: ! Due: l C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature Medical Examiner Date or 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 Methods of Disposition: 0 BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge) ❑ STORAGE ❑ OTHER (Specify) Place of Disposition t-71 ai < 7 An/ 69 . Date of Disposition � — g - 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740- 000 - 0326 -2)