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HomeMy WebLinkAbout1-41-14w 41 s ,ukp s �' P r� \ .00\ V r 'Pro Is b\16 _ s �' P r� \ .00\ V r 'Pro Is _ fs :7 ' A 4f Uw f Date• c) Nkirk -but i/ Date df Burial Name -of Fun err a Hdme . Rut rized , 'fir at ' I UFllt• B19ok _ Lot +I f I Fate of Mask -or�t � •( t� �►'� a! , Date ©f BWrial ." 1 i e. ' o r "Name of Funeral Authanzed t1y IDA M, RECEIPT #423 P. 0, BOX 209`'3 rl SEBASTIAN, FL. 32958 DEED #1063 LOT 14, BLOCK 41, UNIT 1 ADDITION George Kinsell in erred 2/5/86 (Cremains) Sda K! Gt�i �I;oms werrea( 1p q3 • Paid b CEMETERY Receipt No.... ' ; 3, ........ Dated... 11 / 14 /85 ... . .......... . . Y P List Price $..? Z5:.0.0........ Maximum No. Putial Spaces ......1......... . NO. Net Paid i ... 7 5 00........ Monument permitted ........Flat ............... 1063 Lot 14, Block 41, Unit 1 Addition Ida M. Williams (Pala abate th4 line for City Record only) P.O. Box 2093 y) Sebastian, Fl. 32958 (situ of otbaatiazt l9rmrtrrg ]Dttb No. ices THIS INDENTURE MADE 114 ..........440...... day of ..........Novembex ..... .. A. .. � 1Y 85 . between the City of Sebastian, a municipal carporatioa csistiag; under the Iowa of the State of Floride. as Grantor and Ida M. Williams .... . ........ ........................... .......... . ............................................................... I ............ I....... P. D, Box 2093 .............. SOast'ian...F.Z .....3285,8 .......... I ............................. ............... ............................... . of the County of ........Indian ,River .......... I... • .... and State of ...... Florida . as Grantee. WITNESSETHs That the Grantor for and in consideration of the sum of t ..... , , 7 .00 , ....... , , to it In hand paid, the receipt whereof is herewith ao knowledged, does by this instrument grant, bargain, sell. release, convey and confirm unto the Grantee , ,her . , . belts. legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: 14 41 1 Addition AU of Lot(s) , .... , . , Bbck, ........ ,UNIT ...... . ...... . of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Hook 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; saki land now lying and boing in Indian Rives 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 tines In accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, bonito- fore, now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, restrictions sad 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 you first above written. Clty Clerk L�� iiigned, Sealed and Delivered In th Mae etc STATE OF FLORIDA COUNTY OF 114MAI+F RIVRR CITY OF ARBASTIAN, FLORIDA By ......... ........ = &war 1 i\ t Awl � r I 14th November '`'��........ 5 I HEREBY CERTIFY, That an tbla ....... ............day of ... ................ • • • • • • • • • • • • • • • •, 1�..., before am personally appeared ..... • Jim Gallagher ........ and Deborah. C, ICra9e s ........... . respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florl" to me known to be the individuals and officers described in sad who executed the foregoing conveyance to ........... Ida. ....Wi11 Williams ...................................................... ............................... °.............. ,,.. ��,� , and severally acknowledged the execution thereof to be their tree act and deed sa suctk,of ficerp. tbeseunto •duly authorised; and that the Otticiol seal of said corporation is duly affixed tbereta, and the said conveyance is the: act,` acid deed of` sets) Corporation. *ITNESS mi atgmolwre Official seal at Sebastian, to the County of Indian River and state of Florida, the day and year iMt:�torsOald• . .................... -'` N ti Pis State of Fbrlda at My comnivaloa 401 "O5tary Public, State off OMA My Commission Expires Aug. 22, 1"0 aonded Rau TIDY fain - I"--. Inc. 0 0 THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: ..w FROM:�-3,a'._._ %-A k) i�.L,A M:..._. arm ($ 6 D - ) U �Qko q3 , on this / 4 'L day of AJO L). , 19 k for the purchase of the following described Cemetery lot(m) upon the terms and conditions am stated herein: Description of Property: Cemetery Zat (a)# i AlOW0 q I `Uni t# Purchase Prices l �vt,,?�, _,�,� ~ ""'yam Dollars Terms and' conditions of sales �� ► v ��- t\ 31 Igl4i �- This contract shall be binding upon both parties, the salter 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 connditions stated in the foregoing instrument: aka- -,A �Acxullol The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) On the torso and conditions stated in the above instrument. City of IdUstian .- ME. 93 ® State of Florida of Haitalttt af>Id Rtshat>ittlre S1 Statistics FOR BURIAL — TRANSIT PERMIT A. (Type or Print) t. Name of First Middle Last DATE Month Day Year Deceased OF Zia items :3111, #1111 DEATH NoNNOW 249 14l3 2. Place of Death City. Town or Location Name of (P neither. give street address) County Hosp. or ludsm =in! TWO >fi4111111111111i inst. lads= liver Tills" cue Ctstw 3. Name of Medical Medical Examiner Address Phone Number Certifier j 2M 50 Iw�r■lntt fily s N.D. s Physician Tom psi, 71a Nd& 32M 407- �i7 -71I1 4. Name of Funeral Home/ Address Fla. Lic. No . /Rep. No, Phone Nkimber (Area Code Direct Disposer iW 2M stwo : 10iim 11VW ans"S"we =C. ♦d" !r111h 71dWl" 32l" 1 110111IM L 407-=14-MU 5. Check a [j The medical certification has been completed and signed. A completed certificate of death accompanie Appro- this application. priate Box b was Contacted on within 7 hours after death. He /she verified that this death was from natural causes, that there was no accider nor other external cause of death. and that will complet and sign the medical certification of cause of death. c ❑ was contacted on . He /she verified thi , Medical Examiner, will complete and sign th medical certification. 6. Place of so4A s Ti •a H In state cemetery/ em are■kti� Removal Final Disposition: crematory -name /county from state Donation 7 Funeral Director/ ature - F.E. No. /Reg. No. Date Sighed Direct Disposer 1400091952 e. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. ❑ A five day extension of time for filing the death certificate (exdwive of weekends) has been requested and granted as undue hardshit would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a -Furieraw Director / Direc Diapoeer Report" will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for fili the death certificate requested. �1 Regastrar or �G. JCJ ! ,i1�, Date .�0 ff�3 Date a to Subregistrar Signature DUN G AUTHORIZATION for CREMATION, DISSECTION or BURIAL - -AT —SEA rti'lfat Signature , Medical Examiner Date or Medical Examiner, ftb", fin• gave authorization by telephone fo tl3atm ti*R Funeral Director /Direct Disposer. Daabe The Medical Examiner's approval muat be obtained before disposal by any of the above methods. A waiting 5giOd of 48 hours after death is required for all cremations. D. FOR FUNERAL DIRECTOR /01RECT DISPOSER USE ONLY 1. Date Burial Transit Permit (pink copy) was filed with Local Regiatrar- 2. Date Temporary Certificate was filed with Local Registrar. 3. Date complete Certificate was filed with Local Registrar: 4. Follow -Up Efforts 8 Activities (Note parties 8 dates contacted): 5. Name and place of disposition: S.E "'34 - r,,,44 ate, S. Funeral Director /Direct Dkwxx r Report filed: Yea No Date FUNERAL DIRECTOR /DIRECT DISPOSER COPY IRS Form 326. Feb 89 (p,pbm Oct 87 edition wh rh may be used) Sock Nxnber 5740- 000 - 0326 -2)