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Home My WebLink About2-15-12I 7/23/90 lock 15 Paid by CEMETERY Receipt No Dated Unit 2 NO. 200.00 James R. Cummins and /or List Price $ Maximum No. Burial Spaces Rand Robinson Net Paid $ . 2QQ:.QQ....... Monument permitted 841 Dunn Terr 1 288 Donna L. Robinson interred 7/24/90 Sebastian, FL 329 13 Lot 12 40Lot 12 (Data above this line for City Record only) (thy of 'Ptiastian Trinettrg Berl' NO. THIS INDENTURE MADE Thin 23rd day of July between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and James R. Cummins and /or 1288 A. D., 1990 Rand Robinson 841..D.unn..T.exx Sebas nananFkiver58 Florida of the County of an l State of as Grantee, WITNESSETH: 200.00 That the Grantor for and in consideration of the sum of $ to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee t ri e 1 r heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 12 , Block, 1 5 , UNIT 2 of Sebastian municipal cemetery as per Plat Number 1 thereof 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; said land now lying and being in Indian River County, Florida. To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human 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, hereto- fore, now and hereafter adopted or provided for the government and operation of said cemetery. 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 ob- serve 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 behalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year rust above written. Attest: Ya44 Signed, Scaled and Delivered in the.,'resence of: �.e City Clerk STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this 23rd CITY OF SEBASTIAN, FLORIDA By day of July (Ulitg Seal) W. E. Conyers Kathryn M. O'Halloran before me personally appeared and 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 Mr. James R. Cummins and /or Rand Robinson 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 Florida, the day and year last aforesaid. Public, State of My cortuuiaslon expirest /00P 1 rl s I,.a r Name 0/047 Unit Blocky Lot oz. te006 Date of Mark -out c; 3 / 9 C Date of Burial / ? 0 Name of Funeral Home S! /!" 61 =-- Authorized by Time / 0 , ) :%r ( +„ UNIT 2 BLOCK 15 LOT 12 DEED #1288 James R. Cummins and /or Rand Robinson 841 Dunn Terrace Sebastian, F1. 32958 August 2, 1990 City of Sebastian POST OFFICE BOX 780127 0 SEBASTIAN, FLORIDA 32978 TELEPHONE (407) 589 -5330 FAX 407 -589 -5570 Mr. James R. Cummins 841 Dunn Terr. Sebastian, Florida 32958 Dear Mr. Cummins: Enclosed is Cemetery Deed No. 1288 for Lot 12, Block 15, Unit 2. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, 2145 14th Avenue, Vero Beach, Florida. Also enclosed is a form - Return for Transfers of Interest in Florida Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court when and if you have the deed recorded. Very /truly )2/ yo r�s, Kathr'n M. O'Halloran City Clerk KMO:js enclosure • • 625" THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: FROM: t.. J aal tai 5 , earrywr7ts _2424,2t2aiso,-) 8' 11 uaa� %v .eitzav‘ieie7i ,G,L 3.295Y on this pZik.3 day o , 19 for the purchase of the following described Cemetery Lot( ) u n the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)# IP Block# /6. Unit# Purchase Price: Add"." Dollars( $J00• ) Terms and'conditions of sale: ' `caaO7 '.tee.AV This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: (y44•4-4i. The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. ity of Seba an FRS State of Florida, Srtment of Health and Rehabilitative Servillkital Statistics o APPLICATION FOR BURIAL — TRANSIT PERMIT i/` A. (Type or Print) 1. Name of First Deceased DONNA Middle Last LOUISE ROBINSON DATE Month Day OF DEATH 7/20/90 Year 2. Place of Death County INDIAN RIVER VERO BEACH City, Town or Location Name of (If neither, give street address) Hosp. or Inst. INDIAN RIVER MEMORIAL HOSPITAL 3. 4. 5. Name of Medical Certifier NOOR MERCHANT, M.D. J Medical Examiner Address 7744 BAY STREET CENTER SUITE # 2 X] Physician SEBASTIAN, FLORIDA 32958 Phone Number 407 - 589 -0879 Name of Funeral Home/ Direct Disposer STRUNK FUNERAL HOMES /SEBASTIAN Address 1623 N. CENTRAL AVENUE SEBASTIAN, FLORIDA 32958 Fla. Lic. No. /Reg. No. #1228 Phone Number (Area Code) 407 - 589 -1000 Check Appro- priate Box a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies this application. b LYDEE was contacted on 7/20/90 within 72 hours after death. He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that DR. MERCHANT will complete and sign the medical certification of cause of death. c ❑ medical certification. was contacted on He /she verified that , Medical Examiner, will complete and sign the 6. Place of SEBASTIAN Final Disposition: CEMETERY 7. Funeral Director/ Direct-Disperser— In state cemetery/ SEBASTIAN, FLORIDA Removal atory - name /county: IAN RIVER COUNTY n from state n Donation na e / F.E. No. /Reg. No. Date Signed #1672 7/21/90 B. Permission is hereby granted ❑ A five day extension of time would result from filing within Disposer Report" will be filed ❑ No extension of time for filin Registrar or Subregistrar Signature BURIAL — TRANSIT PERMIT Permit No 1228 -90 -394 to dispose of this body. for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director /Direct with the Local Registrar of the County in which death occurred. he death certificate reques ed. Date 7/21/90 Date Certificate Issued: Due. C. 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 disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. D. Methods of Disposition: BURIAL ❑ CREMATION Signature of Sexton ) or Person -in- Charge ) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition SEBASTIAN CEMETERY Date of Disposition JULY 24, 1990 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 edition which may be used) (Stock Number: 5740 - 000 - 0326 -2)