The URL can be used to link to this page

Home My WebLink About2-43-08� � I 1� I a � 3 �W �� . ' _. . __ -. - - . ... ___. -i...._.._.i"_'__"i_-.._i__'__.l.__._._1.._.__J__ l—.l r � d �----" Paid by CEMETERY Receipt No. . . .4.j � . . . . . . . . : Dated . . . Ap z i 1. , 9�, ,198 6. , , . , , . . . . Liat Prioe S . . . � 5 0, 00 . . . . . . . Maximum No. Pu[ial Speces . . . . � . . . . . . . . . . . NO. Net Paid S . . . � 5 Q . 0 Q . . . . . . . Monument permittod . . . .- f.1 � t : . . . . . . . .. 1 G '� 9 �... .• J.C. 6 Jessie Lee Clemons Lots 7& 8, B1ock 43 • PO box 324 tJnit 2 Addition (Dsta aho�e 1�bL Una !o� Gty Record only) Wabasso, FL 32970 �it� D� �P�tMBxt�xi �P1�iP#P�'1,� �PPi1 N�. ,�. 1G'79 TH18 INDENTUAE 1[ADE 1� .....9.�� ...... .... .. . dsy of .... . AAz:�1................................ . A. D� lY..$� .. betvrcen lhe Gty of 3ebnstl�n� a munlclp�l carporatton ezir!!n� undes the l�twr o! the 9t�te of Flo�lda. u araoto� and . . . . . . . . . . . :? , C t . . . . . . . an d . sT.e � � ? e . ?r�.? . .��1.��►R P.S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PO Box .324 .._. Wabasso, F.L 32970 .................... ... ...,.... .............................. ............................................ o! the County ot ...Indian. River ........................ aaJ State ot ...F1 orida.......................................... u Ci►ant�ee. WITN8.88$TH� That the Grantor for and in wnsideration of the sum of S.... 4 50 .,OQ,., ,,,,,,,,. ,,,, to it in hand paid� the rocalpt whoraof is herawith ao- knowledged, doea by this inatrument grant, bacguia, eell, rele4eo. convey and oonfirm unto tt►o Grantea ,,the i z', heirs, legal repraeer►tativa and sad�nr the follnwing property situatod in Sebartian, Indian Rivet County, Florida, to-wlt: All of Lot(s) .� .&, 8� 8�� ,. 4 3...� U�T 2, Add i.t ion � of Sebastian municipal cemetory at par Plat Number 1 th�reof raoouded in Plat Book 2, at page 65 of the public rawrds in the �fsco of the Clerk of the Circuit Court of St. Lucie County of Florida; sa�d land now lytng and bein� in indian River County, Florida. To Iiave and to Hold the same foraver; provided that said property ahall bo ueod aolely and oxalusively for the intermont of the human dead and shall be usad, kept and maintained at all timea in accordance wlth the culoa and ragulationa, ordinnnoos and tesolutione of the City of Sebaetian, Florida, heroto- fore, now and harwfte: adopted or provided for tha governmant and operation of eaid cemetary. The cunditions, reatrictions and toquitemants contained in this inetrument aliall be covenants running with the land. In tho event of tlu failura of the owner of any property situated within said cemetery to ob- aerve and comply with such rulea, ngulations, reaolutiona and ordinanaea and the conditions of the ddod of conveyance 4heroof thon tlu titlo of such ownor in and to said property ahall terminate nnd the same ahaq revert to the City of Sebastian, Florida IN WITNESS WHEREOF, The eaid party of the flrart part has caused thle inatrument to be axacuted in ita name and on its behalf by it� blayor aad uttaeted by its City Clerk and Ita corporate seal to ba horeto affixed, the day nnd year t3rst above written. CITY OF SEHABTIAN, F RIDA Attest � . . . . . . .�G'`.?`•'�.c'A�t ��Z�. � .� .� . . . By �7�i�� . . . . . . . . . . .' . . � . . . . . �„ . . . . .. . . . . C1ty Qerk ' ' �lfij ' My°r � , .. .� Signrd, Sealed und Dcllvered !n the P erence oi� . . . . . . . �. �:��:� � . . . . . . . .. . . . . . . . . . . . . . Q , �� .� �... _,__ �� , �:,:. - - - .: � _ . Name � • i�! . l.f �... i� ; �'1 t7 1^( � � Unit � �► � � • Bloek �..�'"� , � _ � Lot � : { 1 ., ,� Date of Mark-out f� 1 �� Date of Burial �`�`. / t'� c'��J'• Time l� : 4� �. � . Name of Funeral Home 3 ��f '� ��* Authorized b � � ry Y UNIT 2 ADDITION BLOCK 43 LOTS 7 & � � �' . C . & .'essie Lee Clemons � ' PO Bo3: 324 Wabasso, FL 32958 ' f� U 7 ��c � g J. C. Clemons interred Lot 8�- 12/15/89 I�F:PAR�MFNIIM' 11FAI.TN ANI) N1:11.11111.I�n11\'1�. ti1�:R�-N:I-ti A. (Type or Print) 1. Name of First Deceased J. 2. Place of Death County � �°�� STATE OF FLORIDA � � L�/ � EPARTMENT OF HEALTH & REHABILITA E SERVICES VITAL STATISTICS / i � � l/1 APPLICATION FOR BURIAL—TRANSIT PERMIT Middle Last DATE Month Day Year C. CLEMONS DEATH DECEMBER 12, 1989 City, Town or Location Name of �1f neither, give street address) Hosp. or INDIAN RIVER VERO BEACH Inst. INDIAN RIVER MEMORIAL HOSPITAL 3. Name of Medical �hysician Address Phone Number Certifier ENOCH VANN, M.D. p Medical Examiner 2300-5TH AVE. VERO BEACH, FL 567-7111 4. Funeral Home/ Name Address Phone Number (Area Code) 4t2�!€II{�&![�K STRUNK FUNERAL HOME 1623 N. CENTRAL AVE. SEBASTIAN, FL 32958 407-589-1000 5. Check a� The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b� NURSE was contacted on 12/13%89 within 72 Box hours after death. Helshe verified that this death was from natural causes, that there was no accident nor other external cause of death, and that DR. VANN wilt complete and sign the medical certification of cause of death. 6. Funeral Director/ Direct Bi�pese�— c � medical c tification � � �§j�ature � was contacted on . Hel'she veritied that Medical Examiner, will complete and sign the Fla. Lic. No./Reg:�1(o �i1672 Uate Signed 12/13/89 B. BURIAL—TRANSIT PERMIT 1�28-89-548 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 certificate cannot be filed within this extended time limit, a"Funeral Director/Direct Disposer Report" wifl be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for fil' the death certificate requested. Registrar or Date Data Certificate Subregistrar Signature �°�'�% Issued: 12/13/89 Due: C. 0 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 dit��osal by any of the above methods. A waiting period of 48 hours after death is required for a�l cremations. Method of Disposition: � BURIAL ❑ STORAGE ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person•in-Charge ) CEMETERY OR CREMATORY Place of Disposition SEBASTIAN CEMETERY Date of Disposition DECEMBER 15. 1969 This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when thiere is no Sexton► and returned within 10 days to the local County Health Department in the County where disposition occurred. � HRS Form 326, Oct 87 (Replaces May 86 edition which may be used) (Stock Number: 5740-000-0326-2)