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Home My WebLink About2-03-02SHEET NO. TERMS RATING CREDIT LIMIT A , 2 Name D wr P Unit Block Lot Date of Mark-out Date of Burial Time Name of Funeral Home 42 -0- 7 Authorized by -- ,/' il Z4-x.:;OQA - PakUw- t,EMETER Rc4 Bipt No.... 4 ......... Dated ... ........ NO. List Price $ ....30 X. 0 1 ...... Maximum No. Eurial Spaces ....2 ........... Net Paid S ... -30 . ...... Monument permitted ... E1 at .............. 1674 Lots 1 & 2, Block 3, Unit 2 Edith M. Wilkes (Data above this line for City Record only) 197 Delmonte Road Sebastian, EL 32958 (Ittiv of 6rbasttnn (11rlltrtrry ID rrb NO. 1674 THIS INDENTURE MADE TWA .UriRTEEN.TU ...... day of .. MARCH .... ............................... A. D., 19..8h ., between the City of Sebastian. a municipal corporation existing under the laws of the State of Florida, as Grantor and EDITH,M; WILKCS....... .................. ............................... ..................... ...... ....... ............................... . . ............. 1,9 FL.. 3295a ............................ ............................... . of the County of .. INDIAN,_ RIVER .......................... aiwl State of ... F:403I.Q & .......... ............................... as Grantee, WITNRSSETIin That the Grantor for and in consideration of the sum of $ ..300. 00 .. . . . .......... . to it in hand paid, the receipt whereof is herewith ac- mowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee .HER ... heirs, legal representatives and awgns he following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) .. ) &2_ , Block, .. 3 .... , 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. Lucia 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 dead 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. CITY OF SEBASTIAN, FLORIDA Atte !!S- !�'......... `, I-� IL. �/ By� ... r - ::: c . ............ City Clark �, f �cow� _ Signed, Sealed and Delivered In the Presence •of o F. -. ..NQ : ....... ................ STATE OF FLORIDA A /� C WARTMENT OF HEALTH & REHABILITA* SERVICES VITAL STATISTICS APPLICATION FOR BURIAL— TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Edward Stokes Wilkes DEATH March 14, 1986 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. Humana Hospital Sebastian 3. Name of Medical (physician Address Certifier Nasir,Rizwi; M.D. ❑Medical Examiner 7955 Bay St. Roseland Florida 32957 4. Funeral Home/ Name Address �teeamc Pottinger & Son Funeral Home 1200 S. Indian River Dr. Sebastian Florida 32958 5. Check a The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b ❑ was contacted on . He /she verified that Box this death was from natural causes, that there was no accident nor other external cause of death, and that li J V% 6. Fu oral Direc B. will complete and sign the medical certification of cause of death. C ❑ was contacted on . He /she verified that Medical Examiner, will complete and sign the medical certification. 558 March 15, 1986 Signature Fla. Lic. No. /Reg. No. BURIAL — TRANSIT PERMIT Date Signed Permit No. 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. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. Registrar or Lf%ili�fititit ��_. � [�cJ IDssued W a4_e_ / /Mu/, Sub- Registrar Signature 6, 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. Awaiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: BURIAL ❑ STORAGE ❑ CREMATION ❑ OTHER (Specify) Place of Disposition Sebastian Cemetery Date of Disposition March 18, 1986 Signature of Sexton) in:PI1 L e, 119 0 - S'w( or Person -in- Charge Deborah C Krages, City Clerk - City of Sebastian 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, APR. 81 (replaces previous editions which may be used.) 04/13/2010 10:08 7725892583 STRUNK FUNERAL HOME PAGE 02 0210112010 (FAX) P.0011001 Order Acknowledgement ranite Acknowiedgcrrent NO 71387 &I�t�L11V 1* UP a mac Sales Order Date: 01!2900 E�err� J s Pape: 1 70d- Sold To' SEBASTIAN C -;AP -H DAVID HINCEMAN 1623 VORTH C =N TRAL AVE. EEBAS" IAN. FL 32956 Phone' 77:?- 589.1000 `ax . ?2.5&4 -23e3 Sho Via PJO., —RUCK Ea rrtitiod Ship Dale erns N =T 30 DA":3 F're1.;',t PREPAY Sh p To STRUNK F!'NERAL HOME JUANITA 916 17TH ST, VERO BEACH, FL 32960 Phone 772- 466 -1955 Fax. C,jstomer ID 4199 Saes Quote No, P.O Number P.0 Date 011293'10 Sa esPerscn TERRI REEEL v ntR Item No. 921—or Dasobtlon 1 MRKBRP STAR BLUE 4 -0 X 1.2 X 0.6 PFT GRP CARVE & LETTER PER D. I'D', N100 PER A- ToCHEO LETTER IN FROSTED PANEL. r3LAC;K LITHO RE *N LIKES 5EtjD DRAWING FOR AF. ROVA_ W"\Kes /- -- / / ' 'Atj v I � e A01 �F7 y 4// :q /Z le - /r Res,/ LJ