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Home My WebLink About2-42-164 b I Name Block 42 -A Lots 15 and 16 Deed # 425 Mr. Beverly Arthur Payant Mrs. Yolanda Payant 534 Lake Drive Sebastian Uni t 2 Addition mm's !Cl CD' ..J" t 9. p �• o Q- a d1b I i Cb CD w CD �E z x 8 ?o A z cD cD C �t w CD CD co . o o w � O' CD, d (D `1a d P- c�D c� 0 0 A O CD 0 D >< O N (�D e� QO �d x tri CrJ CD CAD El O (D (D N 3 � L. tC t0 R b y n y 0 L 0 cv w N O p n v O� 0. Un no t- o � O CD w CD �E z x 8 ?o A z cD cD C �t w CD CD co . o o w � O' CD, d (D `1a d P- c�D c� 0 0 A O CD 0 D >< O N (�D e� QO �d x tri CrJ CD CAD El O (D (D N 3 � L. tC t0 R b y n y 0 L 0 cv w N O p n v O� 0. t ILLS U1 Ylltl#i1TFIi[ _ No 425 THIS INDENTURE MADE 71& ...,10th December day of .............. ............................... A. D , 1880 .... between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ..................... ............................. Mr. Beverlt� Arthur Payant ...... Mrs. Yolanda Payant " " " " "' ... .........................5.34.. Lake. Ar i ve............................ ............................... Sebastian of the County of .....Indian River Florida and State of ........................ ............................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the'sum of $........ ?00.00 ** ...... 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..2eSr. heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: -~ Block - 4.27-A.-XX Lot S. . _1 . and .1.6. in Seeton 50t11 t! 2 of Sebastian municipal cemetery as per Plat Number I there- of recorded in Plat Book 2, at page 66 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, Florida, 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: Signeealed and Delivered in ! Presence of: /.........!. .... .. ....................... .............. STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA A "Am Mau cseal) I HEREBY CERTIFY, That on this ..... 11th....... _ . „ ..day of ............ December 1 0 , , before me personally appeared ............... Pat F1 oOd r, .Jr... ..... . .... . .... . . and ..... Elizabeth Reid .. ... ... ....... 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 ;...........Beverly..Ai th r and Yolanda Payant ........ ............................... ........................................................ and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorized; 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 seal at Sebastian, in the County of Indian River and State of Flbtida, the day and year last aforesaid. ::kmPublic, State of Florida at Large, mission expires: MW of FWM It t8rge �talon Expires Nov. 28. 1881 a.m.. rr Am~ fin a caawiiy C-Peft sow MIMe., of HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL:. TRANSIT PERMIT 1. Name of First Middle - Last Date Month Day Year Deceased Yolanda Payant of July 2, 2003 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Pinellas Safety Harbor Hosp. or Mease Countryside Hospital Inst. 3. Name of Medical Address Phone Number Certifier Scott Ray, D.O. 2350 Sunset Point Road #C Medical Examiner Physician Clearwater, Florida 33765 727 797 3155 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. NoJReg. No. Phone No. (Area Code) Establishment 4945 E. Bay Drive National Cremation Society Clearwater, Florida 33764 KB229 727 536 0494 5. Check a. F] The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. was contacted on He/sh verified tha is 4eath wasArn 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 within cu C. � was contacted on . He /she verified that , Medical Examiner, will complete and sign the � medical rtification of cause /ofJdeath within 72 hours. %%`� 6. Direct Dispose Director/ /lr�� , . i` %� %/a F /.0 N/. -0� Date 9 -7 0 B. V BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 9229 -07 -646 A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested annd ranted since the physics n "s 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 Certificate Subregistrar Signature Issued: 7 —J%� Due: C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number. % tit Date I— -% M Medical Examiner, NA -P gave authorization by telephone to fly 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. Method of Disposition: BURIAL X❑CREMATION Signature of Sexton 1 or Person -in- Charge 1r CEMETERY OR CREMATORY Place of Disposition Southeastern Cremator JULY 0 9 2003 ❑ STORAGE Date of Disposition i—i nTNFR 1q.- vl 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. DH 326. 8197 ((x soletea aN pprr vbus editions) Distribution: Why Fwarall Diroclor a OikW Disposer (Stack Number: 5740-000-0328.2) Pink: Local RegisOar •• � �< roU�i►1nO 1 1173 0O.�G o a- iza r Uj T 04 r O -4 no p r 3 O O 0 w r r u, i r, 1 N W I CO CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name 1966 ❑ Cash k 1 4e4Z— Amo nlPaid 001001208001 Sales Tax 001501322900 Garage Sales 001501341M. Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501362100 Community Center Rent 001501362100 Yacht Club Rent 001501362150 Non Taxable Rent 001501 343800 Cemetery Lots 601010 343800 Cemetery Lots Lot/Niche . Block Unit 00`1501369400 Interment Fee 001501369400 Weekend Service 680800 220681 Yacht Club Security Deposit 680800 220682 Community Center Security Deposit 660800 220683 Riverview Park Security Deposit `i Total Paid Initials WMfA — of Origin • Yellow — Finance • Pink • Applicant