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HomeMy WebLinkAbout1-40-14, sf O w s � � �L�u.� / ./�•�.� l„ . . . . - . . � .i: . . � . . � ' � . . . . Name I, n., f .f=1 ",�,` K ,�,. . /� ,�, �. ,� oa . ,� G'1 - — '.y�:4 . . � . ' � , .. . . . . � - � . ,y . . � . .. .5. . � - �' � ,� � . , /� J� /..� i / � 1-� t�/ U�iit - � . . �� � ,o.. r • v :�;' . : B1ock ' ` Lot � �� Date of Mark-out _.� � � ��c � ;� Date of � rial__S �` „'1,�_�'� � Time " _ _ _ .,, . .�, , .R • : rjg,,,;_ ,x. Name of Funeral Home �� w. :� . , Authorized b t � �,. i _ - _, � # 6254 August 26, 1986 No. Paid by CEMETERY Reaipt No . . . . . . . . . . . . . : . Dated . . . . . . . . . • • • . • • . • . . . + . . • Lisc rdae s . 325. A.4. . . . . . . . . Maximum xo. ru�ial swoes . . . . .1. . . . . . . . . . . 325 . 00 . . . . . . Monument pemdtted . . . -FZat-.. . .. .. . ... . 1,, Q ,.� 3 Net Paid S . . . . . . . . . . . . . Sandra FieZding Lot# 14 Unit# 1 11196 S. Indian River Drive BZoek # 40 (Data abo�e Wb Une toe pb �� ��'� Sebas�ian, FZa. 32958 _ _ ,_ __ _ ___ Lot# 14 DEED# 1093 BZoek # 40 � Ui22 t#1 , $�2'CE FZ@ ZClli29' ; 11196 S. Indian:River Drive Sebastian, FZa. 32958 � �tf� Df �P�1tt�#t `� _ � � ' �PinPfPxl� �PP� No. .. 1��3 TH18 INDENTURR l[ADE z11� .......26th.. ...... dsy ot ....... August ............................. A. D.. 1�.86 ... Mtween the Clty of Sebwtl�n, a municipd aorporatbn e:bt(n� undce the law� ot the 8tate of Fbrlda. �� annlor rnd . . . . . . . . . . . . . . . . S.andr.�. .k'i.e Zdi.n� . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 11196 South Indian River Drive Sebastian, FZorida 32958 or �!� Co�ncy o� . . ..Indian ,River ....................... aol sr.te ot .. ......FZqrid4�.. ................. .................. u (irantee� W ITN E888TH � That the Grantor for and in consideration of tha sum of s, 325: 00. ..., . ............ to it in hand �id. the reaoipt whereof 11 herewith ao- knowbdged. doas by thu inrtrument grant, bargain, �ell. releaeo, oonvey and oonfum unto tho Grantee ,........ 1�ek�.le�a� nPraentadMa u►d atdpu the following property situated Ln Sebastian, lndian River County, Florida, to-wit: All �f Lot(i) . � `�. . . . Block. 4:�. . . .. , UN1T . , , . �!. . . . . . . . , of Sebretlan muni�iprl aemetery s� per PLt Number 1 thereof roiootded ln Pl�t Book 2, at pa�e 65 of the public re�rd� in the oface of the Cbrk of the Clrcuit Court of 3t. Lucle County of Fbtlda; yid Irnd now lyL� ana belt� in Indisn River County, Fbrida. To Hava and to Hold tho came forover; proridad that wid proparty �Iwll be u�ed alely and excludvely for the intorment of the humrn dead and tlull be used, kept and malntained at aU dmea in accordance with the rulet and re�u4tbm, ordirwnoe� and teatuUon� of the Clty of 9ebattltn. N'lorlda, heteta fote. now and hereaftec adopted or provided for the government ead operatbn of �sid cemetery. The oondltlon�, rettrlctlont and tequlrembntt conWned in thie instrument ehall be oovenanta running with the land. In the evant of the failuce of the ownor of any property situated within wid demetery to ob- serve and comply with such rules, regulationa, rasolutions and ordinanas and the conditiona of the dded of convoyanoe thoreof then tha titb of tueh owror in and to raid property ahall tarminate and tha wme shal! revert to the City of Sobaatian, Florida. , IN WITNESS WHEREOF, The said party of the firat part hss caueed thia instrument to be executed in ita name and on ita behalf by !tt INayor and attested by ita City Clerk and its corporate xal to be heieto affixed, the day and yeu fust above writton. CITY OF SERABTIAN, IDA /��� Atter•tf .�... ........... . ... ...�.�. �.... �'�''� 8� ... ... ..........,......................... _ � Gty Ae�k /`c�i H'�TQr 3ignrd, Serled and Dellre�ed - '' . In the oti _- , (.�t /� /e�f - . . . . . . ��lt.�.`� . . . . . y�� . . . . . . . . . . . . . . . . . ,1`�� �t�l ^r "� r �,,_. ... . ..... .(�:�i .................. - _. , ... . . ,,. � STATE OF ARIDA - COUNTY OF 1ND1AN RIVER � � I HEKEBY CER.TIFY. TAst on thU .......l.ftj2...........d�y of• ............A1tg7�8.t........ ;�. ...........� 1�.8G'i, D�tor� me perwnrlly �ppeared . . . . . . . L. Gene Harris . . . . . . . . . . . . . � Deborah C. Kr�zgea . . . . ........... ... .... ... rerpceNvely Mayur end Cfty Clerk ot the City of Seb�atl�n, ■ municlpal corporation under the 4w� o! tbc State ot Florlda to me koowp to br tl�e fndfvidualr w�d ofticen described fa and who executed tbe tocesoin� co�veyance to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sandxra. .Fi.e Zdi.ng . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................ �ad reverally ackaowledgecl the executfon thenof to be their #ree �ct and deed aa ruch officers therruato duly authurfsedi wd t6at tAe Ottici�l oe+l of rsid corpor�tion ir duly �tflxed tbereto, aad tbe� Mid con�eyance is tdc act rnd dc�d ot c�fd Corporstioa WITNES9 my dgnsture Rnd ottklal �esl �t SeDutisn, ln the Couaty ot Indlan Rlver Rnd 8tate ot Fbrlda, t� ds� and �e�e ta�t atorw�ld. . ` .��. .... . . . .. ..... . .. .. ............... Notsry PubUc� ut P'brW�t�p��tC STA OF flORTOA ay ��� �p��� MY GOMMlSSION ExP DEC l0,1O91 OONUEU TNRU GfNER L INS. UNU� t � , 4 I ! t I. I � RECEIPT IS FROM: � � THE SEBASTIAN C�kETERY Ciey of Sebastian Sebnst�sn, Florida ACKNOWLEDGED OF TNE SUN OFs • 'T�l� �i�c-�v+-{� �/l�Gt' i , yti9 ars (���, � � on this day o � ,_.2•Sl�o for the purchase of the followin� described Cemetery Lot(s) n the terms and conditions as �tateQ hexe.tn: Description of Property: � Cemetery Lot (s)1i� elockN Uniti► � Purchase Ps��ce� ��M,tc �-�.�vr.� �,�l�l� Aallars (S i�J ,� ) Terms and'conditions of sale: C,c���+ �(c . S9/� � � ��� This contract sha11 be binding upon both parties, the seller and the p�rrcha�ter, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and aonditions . stated in the foregoing instrument: —�.�t�(-l�-� � �� The City of Sebastian agrees to se1Z the above mentioned pxoperty to the above r�amed purchaser(s) on the terms and conditions stated in the above instrument. •/ / � � ._.�.� �►. , -C��/''�%��.-�/ � . Gity o� Sebastiat� G�`"' . , �NU�� �� �� S7 � � A. 1. Narne of Deceased (Type or Print) STATE OF FLORIDA �EPARTMENT OF HEALTH & REHABILI�VE SERVICES VITAL STATISTICS APPLICATION FOR BURIAL—TRANSIT PERMIT � First Middle /�9 �0%3 l.ast AT E OF ARIENNE (NMN) FIELDING DEATH Aug. 24, 1986 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Indian River Memorial Hospital I 3. Name of Medical ❑ Physician Address I Certifier Leonard Walker, M.D. �ledical Examiner 4001—B Virginia Avenue., Ft. Pierce 4. Funeral Home/ Name Address Direct Disposer STRUNK FUNERAL HOME. , 734 N. Central Avenue. , Sebastian, Florida 32958 5. Check a� The medical certification has been completed and signed. A completed certificate ofdeath 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 I will complete and sign the mediCal certification oi � cause of death. i ,� y� _ �v�� ` ���� . ��5��' �, yb Month Day Year 6. Funeral Diiector/ IIiFeet-Brsryese�. � ��( John iassistant) was contacted on 8�25 . H�/she verified that �i Dr. Walker , Medical Examiner, will complete and sign the medical certification. i nature � �..� _"l� `C ��L �. Fla. Lic. No./Reg. No. BURIAL—TRANSIT PERMIT Date Signed August 26, 1986 I Permit No. 1228-86- Permission is hereby granted to dispose of this body. I [� 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. j Registrar or Sub-Registrar Signatu 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 Methocl of Disposition: � BURIAI � STORAGE � CREMATION � OTHER (Specify) Signature of Sexton ► or Person-in-Charge ► Place of Disposition Date of Disposition. . This permit must be endorsed by the Sexton or person-in-charge (or by the F r�ral Director/Direct Disposer when Rhere 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.)