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Home My WebLink About2-43-07j ��/ � � � �s � � � � j 7 . . . . . ___-� . . 3 -�W �� '� �� . �, __ ______ .� �= -----�-_ .� � , .-- � , � , � �� . . . � � . " ��"" •_ _......_„��.. � J � FY��i � �� _ _ ( . ...._. ...._.' "_".'_ .� ' "'�.�'_ i. -...__:�._:_" i__� . . . J."____A_.__"_J__ � . . . � � . . . .. . '. . � /� 0� � `�*:. , �i w¢ . J� � � C�� .. � � :. . �� . p ...:�„q . . � - �� ;�� - � �; : � �:,-� � � � ' ~� , ' +'`�� : . . . 7 ) . . � � i � � S ��o � ��`� r , � Paid by CEMETERY Reaipt No. . . .4 � . . . . . . : Dated . . . Ap r i 1. . 9,. . �. 9 8 6. . . . . . • Lut Prioe s . . . Q 5 Q . �Q . . . . . . . NaP�dS ...95R.QR....... Lots 7� 8, Block 43 Unit 2 Addition ltaximum No. Putial Spwae� . . . . � .. . . . . . . . . . Nonument permltted . . . .- f 1 � t- , , , , , , , , , , , , (Data sbo�e tbb line for pty lieoord ooly) �it� ,af l3rb�sxi�n �PiYiPfPxl� �PPi1 ` J.C. 6 PO box 324 Wabasso, /, NO. 1G79 Jessie Lee Clemons FL 32970 N�. �. 1 G'7 9 TNI9 1NDENTURE l[ADE 11� .. .. .9.�� . .. . .. . . . . . . . dy+ ot .. . . . Aaxi1. . ... . . . . . .. .. . ......... ...... .. . A. D� 1�..$� .� bstNeen lhe Gty ot Sebastl•a. • munlclp�t oorporatba e:btin� undce the l�ws of the 8t�te ot FIo�Wa. �� Q�anto� sad ...........:?,c�.. ......a�S? .+7e��1e. ��.�. �'1�m4r�� ............................................................................ ..........PO, Box. 324....... Wabasso, .FL...�2970 .............................. ............................................ otthe Cownty ot ...Indian.River ........................ �al 8tste ot ...Florida.......................................... u (3rantee, WITNE88ETH� Tt�t the Grantor for and in oonuderatlon of the �um of S....�� Q•.4Q . ............. to lt in hand paid. the recelpt whereof i� herewith ao- knowledged. does by thia in�trumeat �rsat, ba�aln, �ell. releae. wavey and oonflrm unto the Grantee ,,ihe ��. }��, y� �pte�entatira aod a�d�n� the foqowing propetty tituated in Sebartiatt. Indian River County, Florida, to-wit: All of Lot(a) ,� ,�. 8� Bbck� ,. 4 3...� V� 2, Ad d i,t i on � of Sebadian municipal ametery a� pe: PLt Number 1 thereof noorded La Pbt Book 2, at page 65 of the public records in the otbas of the Cbrlc of the Circult Court of St. Lua�e County of Fbtida; aW land now tpit� �nd b�it� in Indian Rivez CouMy� Fbtkla. To Have and to Hold the same focever; pmvided that wid property shall be uied ably and excludvely for the lnterment of the humu� dad �nd ault be ueed, kopt and maintained at all timos in accordance wlth the ruba and regu4tion�, ordinanoee and reaolutionr of the City o[ Sebattian� Florids. he:eto- fore� now and hereaPter adopted or provided for the govemmeat aad operatioa of �aid cometery. TLe oonditiont, rortriotlon� and cequicemantt oontaiaed in this inrtrument thall be covensntt runnin� with the l�nd. In the event of tho failuro of the owner of any ptoperty �itwted withio aid'oemetety to ob- eerve and comply with such rule:, reguladon�, realutions and ordinunces and the conditiona of the debd of ooaveyanae theteof then tLe titb of tttch owner in and to nid propeaty ahall terminate and the ame �hall revert to tha City of Sobartian, Fbrida. IN WITNESS WHEREOF. The eaid paity of the tint part hrs aured thi� lrutrument to be executed in ita name rnd on IU behalf by it� Ddayor and attested by ita City Clerk and lta wrporate �eal to be hereto af6xed. the day and year fitst above written. Atte�t: . . .. ...{�lS?�V. LI��i i:IGA.Y...�.� .� c.�,L.�� Clty Clerk �'�!' . � � `_�'�'1. Si�nrd, Sealed rnd Dellvered la tAe P acs oti ... ... .�.�6!`:4 � ...................... Q � W� 3TATE OF FLOItIDA COUNTY OF INDIAN RIVER CITY OF SEHABTIAN. F AIDA 8� .... . ....�y� .. , ......,.`......... ..+ .... -�� r �� .. " . ' " " • , + : .,., : ,_ .. :•ti.� � � _ ., . I HEHEBY CERTIP'V. Tb�t on tbL .. . . . . . 9 th. . . . . . . . . . . .d�y oi . . . . . �i�F. �.� . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . ., , . : . . .., -1!.$�. betore me perwnsily •ppe.red ...L,,.,Gene Harris ................................... sad .. Debot;�b..G,..K.r��r�........... re�pectively Msyor rnd Clty Clerk ot the pt� of 8eb�utlan. a munklpd corporstlon under tbe I�w� of t6e 9bte ot FbrWa to me �oow� to be the IndlviduMlr +uxi ofticers desc�lbed in sad abo ricecuted tbe toce`oln� co�veyanee to J.C. 6 Jessie Lee Clemons .........,.. . .... ................................................................................................................. ........::...................................... ....... sad �e�ee�lly �cicoo�rled�ed tl►e e:ceutlon tbereot to be tLels free act aad d�ed u �ueh offtoera thera:nty dnly authorisai� sod t�t t4e Otiiclal wi ot wld oorporation b duly �ttiud tberetq, �1 tl�e 1l�ld con�eysaee 4 tlw �ct aad deed of �aM`corpontbn. W1TN.�88 my sl�a�tnn �ad dtkW �1 at 8�bwtMa. in tbe County ot Iadi�n Blrer and St�te ot FbsMIM the dy a�d �Mr I�st doraMid.: ' _ - � - . . ..�G[.... ...................... Nota Publie. 8tate ot . a I.u/e. Y� eosslaloa e�cplra�otary Public. Sbte of F1q�j� My Commission Expires Auy, u� �� Bond�d Th�u iroy fy� .�w�wu ��` v _ . 1 . .. - ' - � 4 -- �...r� Name �.., Unit :.�i Block ' Lot _ p� �..5:.� r' +...`ir� ,. ---- --- ---_------� Date of Mark-out `� 4° t� �/'��,. � � Date of Burfal := f�:.-. ! �`� ,� Time �:'� :�.na Name of Funeral Home �..>�r+r. r: .•, t< ` ,___ ! � , , r^ � �, � , „ rc AUihOrlZ@d b `� �,'' � � r `-� �'.� y' �- ,f;` A I 1 . _ _.__ .. .._ ... . ... .. _.. __ . . . ._ . ..._. . . .. . CLEMONS, �'. c. AND �'ESSIE LEE �� Bo�, 324 Wabasso, FL 32958 Lots 7 & $� Block 43 Unit 2 Addition �/ l,if �,�� `! �! �v.' �� J• �• Clemons interred Lot $ �J�SS�� ,� l� - 12/15/89 � 31��9� �` State of F�orida, Depar�t of Health and Rehabilitative Services, V' tistics APPLICATION FOR BURIAL — TRANSIT PERMIT � �Q �- /3 y 3 u a /� A (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Jessie Lee Clemons �F U3/23/1992 DEATH 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River 3. Name of Medical Certifier Dr. E. J. Vann 4. Name of Funeral Horr Direct Disposer Strunk Funeral 5. Check Appro- priate Box Sebastian Medic M . D . X Physi� Address 1623 Iomes, P.A. I a ❑ The medical ce this application. Inst. 434 Fleming Street Address 2300-5th Ave Vero Beach, Florida 32963 Fla. lic. No./Reg. No rth Central Avenue an, F1 32958 1228 �s been completed and signed. A completed Number (407)56i-711Z Phone Number (Area Code) (407)562-2325 'icate of death accompanie; b�] n�hAr� was contacted on t1� /�d /i q4anrithin 72 hours after death. He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death, and that Dr E. J Vann . M. D. will complete and sign the medical certffication of cause of death. c❑ was coMacted on . He/she verified that , Medical Examiner, will complete and sign the medical cert'rfication. 6• Place of Sebastian Cemetery �n state cemete / Removal Final Disposition: aema - �cou�tY� Indian River from state Donation �• Funeral Director/ � Sign r F.E. No./�leg�No. D�te Signed C��irae�-9ieF�ese�. B BURIAL — TRANSIT PERMIT 1228-92-0151 Permit No. 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 certfficate 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 i the death certificate sted. Registrar or " � Date �� Date Certific�te Subregistrar Signature ��d' �' C. � AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA � Signature , Medical Examiner Date or Medical Examiner, , gave suthorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by arry of the above methods. A waiting period of 48 hours after death is required for all cremations. Methods of Disposition: ffi BuRU� ❑ CREMATION Signature of Sexton ) or Person-in-Charge ) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY P�ace o� Disposition � e b a s t a i n C e m e t e r y Date of Disposition M d r C h 2 6, 19 9 2 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 edkion which may be used) (Stock Number: 5740-000-0328-2) ,. � � �. u TNE SEBASTIAN CEMETERY City oF Sebastian Sebastian, F3orida RECEIPT IS HSRTs9Y ACKNOWI.�AGED OF TH� 8UN OFs 7�SZtit l�7lv�t��- �f�,�n l�•�c,at o FItOM: �--�• � � . �' �="` �� ,Q� 3, � ,, ,,, � , �/3 S�" Iars (� 'y�� on this � day of il�� ,_l9� for the purchase of the following described Cemetery I�ot(sJ pon the tarms and conditi�on� as ��ated bar��ns Descz�iption of Property: ' . Cemetery I•ot (s) #1 ,7 � � B.IockN_ �3 Un.i�1l „� ��,�c�`�,,l� Purchase Pr.tce: y�p,�.�. �a �f,� _ Dallar� (,S�l v� Q�% Terms and'conditions of sale: d• �,. ��.�1 � 7a2 � This contract shall be binding upon both part.tes, the �el�er and th� pWrchq,�er, wt�en approved by the owner of tha property above described. I, or we, agree to purchase the above des�z�ibed proper�y on the ��xms and conc�it3ar�� s�ated in the foxegoing insttutaent: L� �'7 l�''4.� , The City of Sebastian aqrees to se1Z the above tnentioned property to the above Aatped purchaser(s) an tl�e terms and condit3ons stated in the above instrument. . Wit ess �D City o#' bc�stian � . � �