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Home My WebLink About1-41-06(Al F�,4 P4 rA NGual 13 L) I-sA i I Al 545 Lu rr-N.. 3 IV P4 rA NGual 13 L) I Al 545 Lu rr-N.. 3 Paid by CEMETERY Receipt No.....•? `........... Dated ... 11 / 13 /85 . . .... . . . . . .. . . . List Price $ .... 300;00,,,,,, Net Paid $ , , , 300... , , ... . Lots 5 6 6, Block 41, Maximum No. Puma Spaces... -.? .......... . Monument permitted .....Flat ... ,F1 a t .............. Unit 1 Addition (Data above dnls Ilse for City Record only) (iitia of Oebaatian NO. 1064 Norman 6 Rhoda Cass. 13336 Roseland Rd. Sebastian, F1. 32958 01 Pinrtr r PP NO. 16-64 THIS INDENTURE MADE This ........ 13th........ day of .......... November ....................... A. D., li.. 8.5 . between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Norman 6 Rhoda Cass ............................................................. ............................... ............. ............ .. 13336 Roseland Rd. ...............Ssbas t inn, .. F.i .....325 5.8 ............. ............................... ............ ............................... . of the County of .....Indian River ........... awl State of ........................ ............................... u Grantee, WITNE88ETHa That the Grantor for and in consideration of the sum of $ , , , , , 300: 00, . . ..... . .. . . . to it in hand paid, the receipt whereof h herewith Go- knowledged, does by this instrument grant, bargain, soil, release, convey and confirm unto the Grantee , the i r. , halts, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 5. & . 6 Block, . 41.... UNIT 1, Addi t.ion , 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 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 bohalf 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 SE TIAN, FI.O41AA, Attests ...... Y..:.. .. By ...... .......r.: � � :,. � ............... . City Clark rMaySr -.. 1 signed, Sealed and Delivered in the P we oft -� �'- x..�... ............. ..... STATE OF FLORIDA STATE OF FLORIDA &RTMENTOF HEALTH & REHABILITA*ERVICES VITAL STATISTICS APPLICATION FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Norman Edgar Cass DEATH Nov. 9, 1985 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 MCPhysician Address Certifier George Mitchell, D.O. ❑Medical Examiner 7925 Bay St. Roseland$ Fla, 4. Funeral Home/ Name Address x5&€*jB6tWW Pottinger & Son Funeral Home 1200 S. Indian River Drive Sebastian Florida 32958 5. Check a [x 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 will complete and sign the medical certification of cause of death. . c P was contacted on /sha— verified that coHe Medical —Exe , will mpletre and sign the me cal certification. VOK2558 November 10p 1985 6. Fu ral Director/ Signature Fla. Lic. No. /Reg. No. Date Signed B. BURIAL— TRANSIT PERMIT Permit No. 7590632 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 ` Date Sub-Registrar Signature ��- -� '�'�•� � Issued 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. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery [BURIAL [] STORAGE Date of Disposition November 1985 [] CREMATION [] OTHER (Specify) Signature of Sexton ) n or Person -in- Charge ) a — gc 40 Deborah C, Krages, it C1 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.)