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BLACK 46 Lots 9 and 10
Unit 2 Addition
Deed # 426
George and Marjorie Fegenbush
526 Palm Avenue
Sebastian
George interred 12117180, lot 9.
r
(ilttu of 1111�rhastiv" _
N? 426
THIS INDENTURE MADE This .......19th......... day of ..............December ................... A. D,
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida,• as Grantor and
George and Marjorie Fegenbush
....... • .............. t .526 Pe1m Avenue.......... .
.................... ....... Sebastian ....................... ............. ...............................
of the County of ... ...
Indian River and State of ..... Florida . , . . • , . .
...... ............................
ms Grantee, WITNESSETH:
That the Grantor for and in consideration of the sum of,$........ I . , DO ** .. . . . . . . . ..... . to it in hand paid, the receipt whereof
is herewith acknowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee..her.... heirs, legal
;representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit:
Upit 2 Additiol�
Block.4.6• , .. Zff Lot S ...9.. &...I 19 ..... in So* ............. of Sebastian municipal cemetery as per Plat Number 1 there -
of 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.
To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of
the 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, Eibrida, heretofore, now and hereafter adopted or provided for the government and operation of said ceme-
tery. 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 observe 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 be-
half 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: 4 ............
City Clerk
Signed, Sealed and Delivered
in t resence of
. ......................
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA
if ....
l '
By.'.. .................... .. � �...... .
Mayor
I HEREBY CERTIFY, That on this ....22nf3 . . . . . . . ....... day of
(Cau gal)
......... DeC4'I 1712Px ..............................I i9 80.,
Elizabeth Reid
before me personally appeared ............ P4.1; • F2 QOCI r • •ar
.. . . ... .. .... .. ... ......
.......... • •
.............. ...... .
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
.Mar jori e. F.egenbush ........................
and severally acknowledged the execution thereof to be their free act and deed
as such officers thereunto duly authorised; 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 Real at Sebastian, in the County of Indian River and State of Florida, the day and year
last aforesaid.
................
of ry :�,i lic, State of Florida at Large.
y on expires:
notary Public. State of Fonda at Largo
My Commission Expires Nov. 26, 1981
STATE OF FLORIDA>
rk RTMENT OF HEALTH & REHABILITATIV ERVICES /� y
VITAL STATISTICS
APPLICATION FOR BURIAL — TRANSIT PERMIT 02�/
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF July 29:
Marjorie Rose Fegenbush DEATH
2. Place of Death City, Town or Location Name of (If neither, give street address)
Co nt Hosp. or 526 Palm Avenue
�i han River Sebastian Inst.
3. Name of Medical ®:Medical Examiner, ❑ Physician Address
Certifier
Ronald Reeves, M.D. 4001 Virginia Avenue Fort Pierce, Fla.
-
4. Funeral Home/ Name Address
QkXqC3&XMwc Pottinger & Son Funeral Home 1200 S. Indian River Drive Sebastian, Fla. 32958
5. Check a The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate b ❑ was contacted on - . He /she verified that
Box this death was from natural causes, that there was no accident nor other external cause of death, and that
will complete and sign the medical certification of
cause of death:
c ❑ was contacted on-. He /she verified that
Medical Examiner, will complete and sign the
me rti i at' 0 2558 July 30, 1987
6. Funeral Director/
Signature Fla. Lic. No. /Reg. No. Date Signed
`
XXQjffA I XWJtKXX
B BURIAL -- TRANSIT PERMIT Permit No. 759-734
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. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Report"' will be filed
with the Local Registrar of the County in Which death occurred.
Registrar or ` Date
Sub- Registrar Signature Y.O.i.iec� 8'-� Issued_QLdd-:1C4l
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature
or
, Medical Examiner 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: .
® BURIAL ❑ STORAGE
CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge )
Place of Disposition Sebastian Cemetery
August 1, 1987
Date of Disposition
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.
HRS Form 326, APR. 81
(replaces previous editions which may be used.)