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Home My WebLink About1-41-04w 41 s 13 s sI is I Al 10'85 �p 6, 1,A, to Lum 31 TtI car 3� �g 16 13 s sI is I Al 10'85 �p 6, to Lum 31 TtI car 3� AN t P A ku CIS C m LL N fli #g of Or"Is #ion altmeterij Berb NO. . 166 THIS INDENTURE MADE Tlls ...25tb ............. day of ....... Navetnber ........................... A. D.. 1 between the City of Sebasttary a municipal corporation existing under the laws of the State of Florida. as Grantor and CHAMM IDE REE WE.STCO'IK ....................................... ............................... ................. . ...... . ..442 EASY S'T'T .......... ,SEBASTIAN,, ,FLORIDA .. ..32958 ........................ ................ . .................. . of the County of ......Indian River ......................na state of .Florida .... ............................... as Grantee, WITNESSETHr That the Grantor for and in consideration of the sum of $ ..300, %w ................ to it in hand paid, the receipt whereof is her. knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , his.... heirs, legal representatives u the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) .3.,&. 4 , Block, .. &I , .. , UNIT .1. Addition , of Sebastian municipal cemetery as per Plat Number 1 thereof recordt 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 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 be used, kept and maintained at all times in accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florid fore, now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, restrictions and requirements c 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 cemetr serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of sn 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 k attested by its City Clerk and its corporate seal to be hereto affixed, the day and year first above written. CITY OF SEBASTIAN. FLORIDA At`... By ... c,.,..,, ....... City Clark Signed, Sealed and Delivered In t A STATE OF FLORID - I - COUNTY OF INDIAN RIVER 25th say of November , �;.:. . . . I HEREBY CERTIFY, That on this .......... ...................... before me personally appeared .... DC • ..$ and .. J. ��rW ....... respectively Mayor and City Clerk of the City of Sebastian. a municipal corporation under the laws of the State of Florida to to be the individuals and officers described in and who executed the foregoing coaveyance to .................. CHARLES . ZDE M ESTCO' IT....,.....,.................................. I.............................. and severally acknowledged the execution thervot to be their free ac as such officers thereunto duly authorised; and that the Official Berl of said corporation is duly affixed tharrto. rad'the said Is the act and deed of said corporation. _� -_ _ _ ��fl�n- nn tM (`n .ntv o[ Indian River and State 00 Flo rlils. the day QState of Florida, Departmen Health and Rehabilitative Services, Vital Sta ' ics /,{ /y� APPLICATIOR BURIAL - TRANSIT PERMIT • /✓ A. (Type or Print) 1. Name of First Middle Last DATE Month Clay Year Deceased Charles 1de Westcott DEATH 03/26/96 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Melbourne Inst, 251 Florida Avenue 3. Name of Medical Medical Examiner Address Phone Number Certifier 720 E. Haven Avenue John Potomski. Jr., D.O. Physician Melbourne, Florida 32901 (407)724 -4545 4. Name of Funeral Home/ Address Fla. Lic. No. /Reg. No. Phone Number (Area Code) Direct Disposer 1623 North Central Avenue Strunk Funeral Homes, P.A. Sebastian, F1 32958 1228 (407.1..562 -2325 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b [. Pat was contacted on 03/26/96 within 72 hours after death. He /she verified that this Join Potomskl de th was from natural causes, that there was no accident nor other external cause of death, and that , Jr. . D. J. 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. 6• Place of Sebas t i an Cemetery , In state cemetery/ Removal Final Disposition: crematory - county: Indian River from state Donation 7. Funeral Director/ gnature F.E. No. /Reg. No. Date Signed I3ca- aiet�saet= t Z, 03/26/96 B BURIAL - TRANSIT PERMIT 1228-96-0162 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 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 the death certificate requested. t �r.,er ` , Date Z4 1 q �i. Date Certificate . Subregistrar Signature --y 1� Issued: Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA 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. D. CEMETERY OR CREMATORY Methods of Disposition: Place of Disposition Sebastian Cemetery 91 BURIAL ❑ STORAGE Date of Disposition ;n-r-h 9A , 199E ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in- Charge) 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 Aumber: 5740-000-0326-2)