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Home My WebLink About2-50-10W � ,y /�.� � - � �o i� Receipt No. . . . . ��?.. . . . . . . Dated . . . . 4�29�86 . . . . . . . . . .. . . . . . : ��....... .�� Maximum No. Euiial Spaoes . ..?. , ... .. . . . . Monument pernutted . . .'��.�t- . . . . . .. . . .. . Lots 9& 10, Block 50, Unit 2 Add. (Data sbove tfils line for Gty Recoed odY) NO. Milton & Dorothy� � `y $ Hedberg - 910 Red Bud Road Barefoot Bay, � 32958 �it#� nf ��b�tt�ti�n �PYItP�P��1,J ��P� No. ic►�� THI3 INDENTURE MADE 'h4 ..17th .............. a.y oi ... OCtObEr............................... A. DM 1Y.86..� betMeen ihe City ot 9ebartian, a municipel corpo*atloa �ist[n� under the lswa ot the 9tate ot Flo�tdr. a� �rantor snd ...,...Milton,and.Dorothy„Hedberg, 910 Red. Bud,Roaci,,Barefoot. Bay,,FL.32958,,,,,,,,,,,,,,,,,,,,,,,,, ............................................ ....................... ot the County ot ... ��C:Y��S� ............................... aal Stste of ...�'�Q7=�4i$.............:............................. u Grantee, W ITN �88ETH � Ttiat the Grantor for and in consideiation of the sum of S..7QQ .�.•••••••••••••••� it in hand paid, �e receipt whereof is herewith ao- knowledged, does by this inatrument grant, bacgain, aell, rel�se, convey and oonfitm unto the Gtantee �1@lX'. . ho' , laBal representatives and assigns the following pmpertY situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) 9. t�Q. . B1ock. . S.Q ••.., UNIT .2. E�dC�... .... , of Sebastian muniuipal cemetery as per P1at Number 1 thereof recorded in Plat Book 2, at page 65 of the public records in the offtce af the Clerk of the Circuit Court of St. Lucie County of Florida; sai�d 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 exclusivaly for the interment of the human dead and shall be used, kept and maintained at all times in accordaace with the rulas and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereta fore, now and hereafter adoptad or provided for the govemment and operation of said cemetery. The conditions, iestrictions and requicements contained in this instrument shall be covenants running with tha land. In the event of the failure of the owner of any propertY sittwted within eaid cematary to ob- serve and comply with such rules, regulations, resolutions and ordinances and tha conditions of the d�ed of convaYance thareof then• tha title of auch owner in and to said property shall tecminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of tha fust part has cauaod 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. CITY OF SEHABTIAN� F. IDA . . Attest : �±��. . • `'� • . . . . �s4��" " " " " . . . � " " " _ _ _ _ . . . B� . . . . . . � . . . . . . . . . . . . . . . . . . . . . . Clty Cler1� Mw�or Signrd, Sealed und Dclivered 1n the reeence of: --- � �%/�.. /.��. . .�' ..� . .. . .��;.. .... . .G�!..Q.�,�.�-�-w . . .��. . -�-�.�' : . . . . . . . . . . . . . . . . . . . STATE OF FIARIDA (�itg �f�al) a� � FLORlDA DEPARTMENT OF HEALT (TYP E) Name of First Deceased 2. Place of Death County Brevard State of Florida, Department of Health, Vitai Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT Middle Last Date of Doroihy B. City, Town or Location Melbou rne 3. Name of Medical Certifier �ohn Potomski, D.O. Hedberg Death (If neither, give street address) Name of Hosp. or Inst. �/� � �� o? /{A.O. Month Day Year May 22 2001 Mariner Health of Atlantic Shores Number 721 E. New Haven Avenue Melbourne FL 321-724-4545 Medical Examiner Physician ' 4. Name of Funeral Home/Direct ai�peeRl� 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 Appropriate Box 6. Funeral Directod aireel�sisAesar a The medical certification has been completed and signed. A completed certificate of death accompanies this application. b. � Donna was contacted on 5/ 22 / O1 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Potomski will complete and sign the medical certification of cause of death within 72 hours. c. � was contacted on He/she verified that , Medical Examiner, wiil complete and sign the of death within 72 hou�s. F.E. No./Reg. No. �, 1862 Date Signed 5/22/01 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispase of this body. Permit No. 1228-01-0260 � 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. - ��r Date Date Certific te Subregistrar Signature �. o� ,�-. hA. �i� J2�t. Issued: s I2Z'� ( Due: s��1 ( � j 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. p. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery �BURIAL �STORAGE Date of Disposition /J 1,� /o%� � �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 tnere is no 5exton� ana returnea within 10 days to the local County Health Department in the county where disposition occurred. Distribution: WhAe: Cemetery or Crematory DH 326, 8197 (Obsoletes all prevbus editans) Yelbw: Funeral Director or Direct Disposer (Stock Numbar 5740-000-0326-2) Pink: Local Registrar Name _..�i(`_, t- D `%1`� Y �' / / � `� ,('�; � �'i !,-- Unit � � ��t� _ _ __ B�o�k � J Lot �� Date of Mark-out -� /�'� r' r� � Date of Burial 7�� « � Name of Funeral Home � I -->T ��•l'� Y��f% f-� Authorized by Time � � � U �