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Home My WebLink About1-40-03�� w � � � �� i �� „ � � � � r a y CEMETERY Receipt No. . . . 4 U � . . . . . . . Date�i . . . . 5 13 8 . . . . . . . . . . . . . . . . . . NO. List Pricx S . .600 : 00 . .. .. . . . Maximum No. Pwial Spaces . . .4. ..... .. . .. . Net Paid S . .600 , 00 . . . . . . . . Monumnnt permitted . . . F1.a t . . . . . . . . . . . . . . . ... 1 lJ �� J Orville V. Co1e Lots 1,2,3 6 4, BZvck 40, Unit 1 Addition 701 Wimbrow Dr, (Dato �bove tbb Une for C1ty Ii�cord only) Sebastian, Florida 32958 �"tfg nf �rb►tt8#i�ttt �l'�1tP�P�`� ��'P� N�. ,: 1.G��9 THIB INDENTUAE MADE 'lib .....13th........... d•y ot ........ Ma.`� ................................. A. D, ll1..85 .. IN�tN'ECp lhe Clty ot 3ebnstlin, a munlcJpal Curporrtlon exl�tin� undcr the lrwe of the 9tute of Flortdu. e� Ciru�to� rnd ............. Orville V: Co1e...............,................................................................................... .............. .... 701 W.imbrow Dc. . ............ �ep��,�¢n...F�.4z:��...,�z?.�8 ....................................... . . . .. ....................................... nf lhc C.oanky o! ...Indian River ........................ �a] 8tatc ut .... Flo.cida........................................ Np Gtanttee. WITN�88�TH� That ihe Grantor for and in considetadon of the sum of s,, n 00 : 0 U.. . ,,,,, to it in hand paid, the raoeipt whereof is herewith ao- knuwledged, doea by thin inrrttument gtant, barguin, aoU, releasa, convey and oonfirm unta the Gr�ntee ,,H1 a.., heka, legul represantativea and usnigr►s tho foqowiug property �itu:►ted in Sebaetian, [iuUan River County, Florida, to-wit: 1 2� 4 40 1 Add i t.ion All of Lot(s) . : . .'. : : , Block, . . , , , . , . , UNIT . . . . . . . . . . . . . . of Sebastian municipal ixmetery ae per Plat Number 1 thareof tawrded in Ylat Buok 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; said L•u►d now lying and being in Indiaa River County, rt�rida. To Have and to HoW the same forever; provided that naid property ahall be uaed aolely and excluaivaly for tt►e intermant of thn human dtlud and shall be used, kept and maintuinad at all timee in accordance with tha rulea und regukttiona, ordinances and cesolutions of the Clty of Sabasti$n, Floride, hertlto- fore, nqw and hareaftar adopted or provided f�r the govornment and oparatiun of auid camatery. The aonditions, reutrictions und requirdmdnts contained in thix instrument ahull be c:ovenanta running with t1W land. In the event of the failuta of the owner of any proparty situated within suuid cematery to ob- eorve and compty with such rulea, reguletions, resolutions and ordinunces and t}►e conditions of the dced of conveyance thereof then ttus titl� of such uwner in and to said property ehall terminate and the same shall revert to the City of Sebastian, Floridu. IN WITNESS WHEREOF, The said party of the tust part t�as caused this inatrument to be executed in ita name and on ita behalf by its Mayor and attested by ita City Clerk and ita corporate aeal to be hereto affixed, the day and year C�rat above written. CITY UF ' I3A81`IAN LORIDA � Atte ts . . rG.�'��..-s�.�"�.,✓. . .�: .`. .!. .�`� . .�.-/ BT . . . .{ . ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... Clty qerl � M or fitgned, 3ealed und Dellvered in the Y'reacnce ot� � . .�? . 1. !. �. . : ��'.`:3��G!i . . . . . . . . . . . . . . . . . . , <� � � f . ��....-.; �- "v.4: �� . .,.. .�4 : �-�Fk i�r�:4 .. . . . . . . . . . . . . . . ,-� 5'fATE llF FIACCIDA A�l�1Yl n�l �YTI" • ��t� ��> Pearl Lee Cole February 13, 1922 - May 13, 2011 Pearl Lee Cole, 89, of Sebastian, passed away on Friday, May 13, 2011 at the Indian River Medical Center. She was born February 13, 1922 in Estill County, KY and was a resident of Sebastian for 29 years coming from Ohio. Pearl was a homemaker. Survivors include her son Tom Cole of Sebastian, FL and two grandsons. � �_ ` f �.' ti: --�-�✓��--�-u'�� v State of Florida, Department of Health, Vital Statistics HEALT APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of PEARL LEE COLE Death M�Y 13 , 2011 2. Place of Death City, Town or Location Name of (If neither, give street address) Counry Hosp. or INDIAN RIVER / VERO BEACH INDIAN RIVER MEDICAL CENTER 3. Name of Medical - Certifier EDUARDO BORJA, MD Inst. 1000 36TH STREET Phone Number VERO BEACH FL 32960 1 Medical Examiner X Physician � —772-567-4311 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment SEAWINDS 735 S FLENI�IG STREET FUNER.AL HOME & CRENiATORY SEBASTIAN, FL 32958 41682 1-772-589-1933 5. Check a. � The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Q EDUARDO BORJA, MD was contacted on M�Y 16 , 2011 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that HE will complete and sign the medical certification of cause of death within 72 hours. �• ❑ was contacted on He/she verified that , Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director/ Signature F.E. No./Reg. No. Date Signed Direct Disposer ��.4,;,�Y n,, ��-- � F057650 MAY 18, 2011 B. c. L BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose ot this body. Permit No. 11-41682-100 � A five (5) day extension of time for fi ing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director nd 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 � a certifi te has been requested. Registrar or Date Date Certificate SubregistrarSignature Issued: M�Y 18, 2011 Due: MAY 23, 2011 Approval Number: IZATION for G�REMATION, DISSECTION, or BURIAL-AT-SEA 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 ali cremations. Method of Disposition: �BURIAL �CREMATION Signature of Sexton � or Person-in-Charge �STORAGE �OTHER (Specify) � CEMETERY OR CREMATORY Place of Disposition SEBASTIAN CEMETERY 0 Date of Disposition MAY 2Q, 2011 i nis permit must be endorsed by the Sexton or person ir�charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned within 10 days to the local Counry Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar S�p 04 zQ09 2:13PM COS CE�ETERY 772z289927 p•Z � � ��, fVNER�I DOpENiNG IN SEBA5 AN MUN! PAL G METERY F4R bUR1A � . S� • ' � MaMCi ► uuwnuvo � ; �ar iniormelion contacL' ' ; Kfp Ks1so - Cematery Sexton � S�bestlan Munlcipsf Cemetery �a � - �� a�l � (7�2) 688-26as ' Clty CJsrk"s bJtice ' C�y yAH, i ZZ5 M91n Strset Sebssllan, �L 92958 p)/fCe (7TZ� 388-82f 5 or 388•eZt� Fex: (7i?1389-5570 � . FUNERAI HOME: � ea�;��; cl � r; �n � AaDR�ss: -� 3� s �= i � �� ;„d��„C� � -i ; c>� � � '�� J pHONE �: � �Check One) ` Lol 3 Btock �"f� Unit n, � C�dc1; �-i' �,� ,��7pEN $URIAL LOT ^i,,,7PEt� CR�MAINS �L4T �at ��k �iU�lt _�..�PEN COLUMBARIUM NICHE NicheT__81p�k �unit � BUf�IAL DATE ANO SERVICE T1M�; t`�_ 1 a� aC ..�� ' �?m FOR D�CEAS�C�: „ 1`� � o,r 1 L.. Co 42 iva�� NqM� AND SIGNATURE aF L07 QWNER �R REPRES�NTA71V�: {Musl provrde prope� dociurr�entation o1 awners�ip) • / � ��Ce i �� C Z�� , t��i�f�9.� � ---,.,._ D le I cerufy that � h eae h�ve bee n pa d a d authoizehopenitlg pf s�me d&��e tha� a�l site tees and adminlstrative 1 , NAME AND SIC3NATURE OF LICENSED FUNERAI DIREC�DF�. ' rn��- S � co 2- Q( 4-� h� �(� (`/1. u-�-i7 � ,gnature Date ---. Name� ------------.._.___..__, __.__... _._._..M-------•-•__.._. . Cernelery Saxton CoRlfic�ticR: � r,erEify t�et I heve�c a hoc e�hfees ha ehbeen pa,tlt�on by viewing the owner'S deeci and cantirming rvith Clerk's otfic�. ; � � �� C rn ery exl n �at I 711is lorm ta be provide� ta C.fe�k's Otfice by Sextan for permanent rec�rd upon comP��tion_ 6'd 6£6668SZLLL H� SdNIMb'3S dtib�b0 6l 96 ��W �IS�°`' � �� Name /��-�-.�__� �n �� 0 3'�'�s � Unit 1 " ,H_ Block `� �ot 3 Date of Mark-out � �6 �� Date of Burial � / �t � G/ Ti m e ' C /`��f .G � Name of Funeral Home 4/'.�__,...rhC Authorized by 7 , � N � S� m i 0 � O �' • ! � f T � r � . � � � � � � �o .9 ei d m c � � Vl � C O 0 -� � � b °o � 0 A W O CT� � o $ $ °o °o °o c ° `L�" `b" o 0 0 0(,,�.) (�,1 (�.1 (�,� p, y� ? .A N O W N O� p t�,a � N O O O O O O O n � o m m � o c�i d n �• � � <° � <° � c� � m -r m Ss' m � y � � � p � � d x T r C ° t�i, � � � �' 3 i� � � . 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