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HomeMy WebLinkAbout1-41-27w Al v QQ /. 11 � c R�uPO� Q vs; to R y 74 Lr �.y wQ � if je I L.(_)rrl -3/ U T �tQiuc- i, rA Gt t_ v QQ /. R�uPO� Q to y 74 Lr �.y wQ � 2,41 je I L.(_)rrl -3/ U T �tQiuc- i, rA Gt 7 J by CEMETERY Receipt No... 4 :'........... Dated ...4 �19 /85 ................... , List Price $ . 300..•00......... Maximum No. Purial Spaces...-. 2. ......... . Mel Net Paid $ 300.00 Flat l- 47 • • • • • • • • • • • • • • .... Monument permitted ...................... • Charles W. Bowen Lots 26 6 27, Block 41, Unit 1 Addition 365 Orange Avenue (Data above this line for City Record only) Sebastian, Florida 32958 (Etty of orhajo# tan we tit rtrr NO. 1047 THIS INDENTURE ]MADE Tbk 19th . day of A. ,, lY..... .. D 85 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Charles W. Bowen 365 Orange Avenue .................................................................. ............................... ..........: VVAM Agn...F,l.9Xi9l ... AMP ......... ............................... ............. ............................... of the County of .. ,Indian River , , aaJ State of . .... ,,,,,,, Florida , as Grantee. WITNESSETHn . That the Grantor for and in consideration of the sum of $ .300:00.. , . • . , • , ... , , , to It in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , h is.... heir the fo wing property situated in Seb 0. le gal representatives and assigns setian, Indian River County, Florida, to -wit: 26627 41 1 add All of Lot(s) , , , , , • • , Block, . , , , , , , , ,UNIT , , , , , , , ition , , , , , , , 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. P 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 4sW, 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- wrvo 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, FLO A At �✓L�,d` G,i�. ..l ... .. B City Clara y .... Myo =..... .,......... Signed, Sealed and Delivered In-1he Presence of t 9--wax-V. . ................ STATE OF FLORIDA STATE OF FLORIDA u w /� I&PARTMENT OF HEALTH & REHABILITJOE SERVICES VITAL STATISTICS APPLICATION FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased ----��— j O F ,l� Util_t1t) _- - DEATH Aowi 1 985 2. Place of Death r City, Town or Location Name of (If neither, give street address) County Hosp. or JAS ©r-onge- Inst. 3. Name of Medical Certifier ® Physician 3AI03 Od"-%�j ;4 Address ❑ Medical Examiner V,tro (3eac.l,. F I or I e 4. Funeral Home / ��11�r Name,, // �y /� / Add es �r ..57�/ aN^ /�Ud�Cr4 / N0/YJ e. ' .3 V A C . �M�s 7 / ZPU"P 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b ® SL` was contacted on 4- 14••ALS . He /she verified that Box this death was from natural causes, that there was no accident nor other external cause of death, and that . ?A../ /�ie��� .� will complete and sign the medical certification of cause of death. c ❑ medical certification. was contacted on . He /she verified that .. Medical Examiner, will complete and sign the 6. Funeral Director/ Signature Fla. Lic. No. /Rey, Pie. Date Signed _L ;d Wgraemoa L'1C;4 I1611 14 - 1qj5_ B. BURIAL "TRANSIT PERMIT Permit No. Permission is hereby granted to dispose of this body. ❑ A five d extension of time for filing the death certificate (exclusive of weekends) has been requested and granted. f t cannot be filed wi hin this time limit, a "Funeral Director /Direct Disposer Report" will be filed ocal Registrar of tWpounty in which death occurred. Registrar or Date n� rz, / Sub- Registrar Sign Issued ,4 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. �� CEMETERY OR CREMATORY Method of Disposition: ® BURIAL ❑ STORAGE ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton 1 , or Person -in- Charge ) .(- t! Place of Disposition .^•��t- •�/���� °t — /T Date of Disposition CZQ. -y i / Q s Deborah C. Krages, City Clerk Q 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.)