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Home My WebLink About2-07-124 1 Ir -13P clq 71 a CO) o- w 17 INI 1 CO) o6 ;f a wa Unit Block Lot Date Of Mark-out Date of Burial 9 9 Time Name of Funerjl Home,, Authorized by_. t _ „ Titg of orhastian trAtetery joPpb NO. -166G THIS INDENTURE MADE Tt,ls ......... 2.0.th...... day of ............ ...May........................ A. D, 19.99..r between tlse City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Aug.ia .. C. Qn aw ..4y ............................... 950 S.W. Dolphin Avenue ....... ............................... Seba t aian,...F•L .. 32.9.5 8 .......................... ............................... . of the County of ..Indian , Riper......... , out State of ..... Florida ............ ............................... as Grantee, WITNESSETHc That the Grantor for and inconsideration of the sum of S 500 • 00 ... to it ' hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee �A r, , , , heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) ,12 , , , , Block, .?. , , , , , , UNIT ?, , , , , , , , , , , of Sebastian municipal cemetery as per Plat Number I 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 first above written. � • ' � � •��.�rGP•v Irk Attests....................... ............................... CITY OF SE ASTIAN, FLORID IIy ..... S.ig . . .�d. ., .S.cxl 4and Delivers: City Clerk a�yol In .L....... ..... P NI� ..... ..........- ........... STATE OF FLORIDA COUNTY OF INDIAN RIVER p I HEREBY CERTIFY, That on this ........ ZQ.th ......... day of ................. May ............................., before me personally appeared , Martha S. Wininger nd Kat . . h . ... ryn M. 0 Halloran . . . . .. ............................ ......... a ...... .. .... 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 .......... ............................... Angie.. Conaway.................................................................... .............................. as such officers thereunto duly Is the net and deed of said d WITNESS my signature last aforesaid. their free act and deed nd the said conveyance Ida, the day and year l � J TAE SEBASYMN CEMETERY' CITY OF SEBASYMN, FLORIDA 1. I'T HEREBY C OW DOGEED OF SUM OF: Dollars ($� FROM: w on this /° day o 19 for the purchase of the following described me ry t upon the terms and conditions as Qherein: Description of Property : - Cemetery Lot, - - -I Block Unit Q� Purchase Price. Dollars erns and Cond14o# of sale: T is 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: The City of Sebastian agrees to sell the the above named purchaser(s) on he terms above instrument. (K77�, an witness ned property to ons stated in the Bx FLORIDA DEPARTMENT OF HEALT A. (TYPE) Stf Florida, Department of Health, Vital tics Ll °2 '� APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased Aleck Winford Conaway of May 18, 1999 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Brevard Palm Bay Hosp. or Integrated Health Services Inst. 3. Name of Medical Bhaskerao P. Patel, MW ddress 5305 Babcock St. NE Phone Number Certifier Palm Bay, Fl 32905 676 9009 Medical Examiner Physician 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1010 E. Palmetto avenue 0000049 407/723 -2345 ownl' 5. Check Appropriate Box Indian River Sebastian Cemete 6. Funeral Director/ Direct Disposer B. a. ❑ The medical certification has been completed and signed. A completed certificate of death accompanies this application. b. [ Dr. Patel's office was contacted on 5/20/99 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 wit In 72 hours. K-E-7' was contacted on medical certific ' ion a of depth witKqY hours. Sigrig F.E. No. /Reg. No. 1049 BURIAL - TRANSIT PERMIT He /she Verified that Medical Examiner, will complete and sign the Date Signed 5/20/99 Permission is hereby granted to dispose of this body. Permit No. 499C73 aA five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has 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. Registrar or Date Date Certificate Subregistrar Signature 62L- Issued: 5/20/99 Due: C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA C Approval Number: 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 all cremations. Method of Disposition: V1 BURIAL CREMATION Signature of Sexton or Person -in- Charge STORAGE OTHER (Specify) CEMETERY OR CREMATORY Sebastian Cemetery Place of Disposition Sebastian, Fl Date of Disposition 2 9 y 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. 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