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Home My WebLink About2-08-06Paid by CEMETERY Receipt No... 5 3 4 ......... Dated ..... $ 2V 88 .............. NO. Lot 6, Blk.8, List Price $ .. 200 : 00....... Maximum No. Burial Spaces ................. Unit Z 1186 Net Paid $ 201) . DG ...... Monument permitted ....................... Evelyn Pate For Cyril Knowles 704 Madison St. Sebastian, F1. 32958 (Data above this line for City Record only) THU of Orhastian (�rmrtPr1,J PPS NO. 1106 THIS INDENTURE MADE Thla ....... Z9.th........ day of ..... Allguat .............................. A. D., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Eve?, yn..Ra> ze.................................................. . ................................ 704 Madison St, Sebastian, F1. 32958 ....................................................................................................... ............................... of the County of .., Indian River .... and state of ........., Florida . ............................... as Grantee, WITNESSETHt 2 0 0.0 0 .... to it in hand p That the Grantor for and in consideration of the sum of $ ...................... � paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee ]I '' .... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) .... 6.. , Block, .. 8.. .. , 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. For Cyril Knowles 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. Attest �-K•..D 'HGC*C. ..... City Clerk Signed, Scaled and Delivered In the resennce oft STATE OF FLORIDA COUNTY OF INDIA'K FIVFF, I HEREDY CERTIFY, That on this .....29th ............ day of .......... A ugld9;.t . ............................... 18.88 CITY OF SEBASTIAN, FLORIDA By.......... .......... Mayor (6itg'irxl) before me personally appeared . Richard B. Votapka and Kathryn M. O'Halloran 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 .................................. ]WgIYn.. P . e................................................... ............................... ......... 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 -aaid 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. '... ` .. nom ................. Notary PubUe, to of Florida vt Large. My commission expirest NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXP DEC 10,1988 BONDED IMRU GENERAL INS. UND. Name Unit Block Lot Date of Mark - out —/ 0 Date of Burial � ` Time 2, -, Name of Funeral Home Authorized by f � I T1lr - 9=AsTIAm czvcTzRr city oe Sebastian Sebastian, Florida ?P7' rS BrRFar ,cxv zzxz.D Op•TNS SUX OF# OJ /o t� bllars Woo. __J -1 o 4F S� -OAT r, is-5 on this day f rdoscri�d `Comoy I Lot (s u 198 for the purchase of tho following pen the terms and conditions as stated huruinj Description of Property: Cemetery Lot(s) N alockM g uni t N 2-- Purchase Price �0o0 D011dts(f s/ °o, o0 TermR and conditions of sale: This contract shall be bin(Un 9 upon when approved by th@ owner o Parti @s, the seller and the Purchaser, Property above described. ?, or we' a9ren to purchase the conditions Stated In Cho 1'ore9onag lotr @uawnt�d property on the forms and '• The City of Sebastian a9r6e8 to sell the above awnt no above me nt d purchaser�sJ on the to ioned property to Cho ing eruu,ersut and conditions stated in the above . n City of S ba s el any .atiG STATE OF FLORIDA Va - /- 6 DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES VITAL STATISTICS APPLICATION FOR BURIAL — TRANSIT PERMIT 14 A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year OF Deceased Cyril Knowles DEATH September 16, 1988 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Indian River Memorial 3. Name of Medical j. ] Physician Address 569-6112 Phone Number Certifier Charles Fischman, M.D. p Medical Examiner 3605 -15th. Ave. Vero Beach, Fl 4. Funeral Home/ Name Address Phone Number (Area Code) IDliiitK Strunk Funeral Home 1623 N. Central Avenue Sebastian, Fla 407 - 589 -1000 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. Box b U Dr. Fischman, M.D. was contacted on 9/16/88 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 He will complete and sign the medical certification of cause of death. 3110 medical certification. .was contacted on . He /she verified that , Medical Examiner, will complete and sign the 6. Funeral Director/ �ignature ��%/ Fla. Lic. No./Reg. '� Date Signed .B+fee�i3isposer G-w /� l Z �'- /G• - �% B BURIAL — TRANSIT PERMIT Permit No.1228-88-424 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' will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filing a death certificate requested. Registrar or Date 9/16/88 Date Certificate Subregistrar Signature �"""�� -f"'�JIssued: Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA C Signature or , Medical Examiner 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: EX BURIAL ❑ STORAGE ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Rage) CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition ,, /5F F7 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. HRS Form 326, Oct 87 (Replaces May 86edition which may be used) (Stock Number: 5740 - 000 - 0326 -2) April 23, 1981 31- 4 Mr. & Mrs. Van Pate loth street P. O. Box 743 Sebastian, Florida 32958 Dear Mr. & Mrs. Pate: According to our records, we are holding the following cemetery lots for your lilt k iP & 16, block 8, Una t.2 As there have been no payments made an them, wrould you pleame, let us know if you are still interested in them. If we do not bear from you within the nextt30 days, we will assume that you do not want them. Very truly yours, Elizabeth Reid city clerk FRIjIf v. GEM lex:RECORD # NEWCEM City of Sebastian, FL - Cemetery Lots Last Name Pate First Name Evelyn Address 1 704 Madison Street Address 2 City Sebastian Deed # 1186 Date Unit # 2- Block # Lot Number 6 Interred Lot Number Interred Lot Number Interred Lot Number Interred Comment Comment <F >wrd <B >ack Thursday, Jan 20, 2005 10:10 AM State F1 08 -29 -88 Amount 8 Cyril Hnowles Cvet> >elete <N >ext <P >rev Zip $200 :715 32958- Dte Interred 09 -20 -88 Dte Interred Dte Interred Dte Interred h <L >abel <T >aa <Esc>