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Home My WebLink About1-40-15�� w s � � �� i �� „ �... '. ..-ir . ,-fC ' � 7 . . ' (�� v � � Y+ I. . ' . . . . � .. ' - , . . . . . . . . . .. � ,. . . �'{ . ' � � . . - . . . ' � i� � � j . � r � . � . . . . � � � ' � r ; � �� x � . N�me %� � ' i ; ,y � . � `:� . . . . � . � - . . . � � � � I . .. �� / ' . . . . . � . �f - � �'r � Unit . i � � , �� I 7 r s�o�k W � y? . � ' { a � , � � r �� I �.. ; , j Lot U; , , _ . , : � � �� t; Date of Mark-out , �� 5 ' �� rx i Date of Burial �" #' � � . 'Time . � � �'' � U =, ��.�. � * '� ya -�,.. ..;� ;�<. � `, y; I�I Name ofi Fune.ral om � , ' �� ; �� .� � k �-: "�� r�r _ ..; I I � � � ��s.:v�� :� � � . � �. . ,. Authori'�e . . :s , �; I � , ?_ . � ; ,; ; . . . 1�.' � . / - ` � �`4..a�ilitY �. .. . . . S tir .y .. , , . . �i j . 4 ,�,' 'i ' . . , d� � , p • i � �" � I� Name � � ' , ,, , � ; - �` Unit ' I� �� i �, i Block '/' � .. _: - . , ;': Lof � �+• x� �' : ..... � ' . ' . � �•.� �°� .. .. ' . . . Date of Mark-out ` %� � �- ", . . �. � Date of Budal �/ f � 'fi / � t� ,ime � ' Q a /,� ✓Y� , r�� • �". �. Name of Funeral Home C ,/~ � , ' . �r �, ,�' ; . � . �i �.. . . . ( ?i[' . � ' . . . . . . .i'I . . . , . . . � . . Authorized by � w � � 4 I . Y� , _. _. . ' E�r� �.,.'`v:� �.:._t.. , '� Paid by CEMETERY Receipt No. . . . 428. .. . . . . . . Dated . . . 1 �?3 /86 , , , , , , , , , , , , , , , , , List Price S.. � SQ. OQ... ..... Net Paid S . .15 0: 00. . . . . . . . Lot 15, B1ock 40, Maximum No. Pucial Spaas . . . . . : �: . . .. . . . . Monument permitted . . . . . . FI a t. . . . . . . . . . . . Unit 1 Addition Beth Ann C1ark� 8005 242nd St. (Data above 13�L Ifne !or Giq� 11�eoord oniy! Sebastian, F1 . CLARK, BETH ANN RECEIPT l�428 � 8005 142nd St. DEED ft1069 Sebas.±ian,'F1. 32958 LOT I5, BLOCK 40, UNIT 1 ADDITION INFANT INTERRED 1/24/86 ��,v w ��- i � ��r,%� �� `� � � � � � �d0. 1GE9 32958 * . 1/23/86 � Paid by CEMETERY Receipt No. . . . . . . . . . . . . Dated . . . . . . . . . . . . . . . . . . . . . . . . . . . . LLt Prioe t . . � 54. �Q. . . .. . . . Ma�cimum No. Pu�ir! Sproe� . . . . . : �: .. . . . . . . NO; Net Paid S . . 1 S 0: 00. . . . . . . . Monument pormitted . . . . . . FI a t. . . . . . . . . . . 4. 1 f , (! (] Lot 15, BZock 40, Unit 1 Addition � Be th Ann CI a rk 1�� v�� 8005 142nd St. (Drb �bo�e tfils Une !or pq R�eaed ody) Sebastian, FI . 32958 �it� nf l3rb�,�ti�n �P�iP#P�'1„� �Pp� "°. , 1G�9 TH18 INDENTURR �[ADE 1tib ..........�3rd ...... d�y ot ....... �?�AUs?�'iJ ............................ A» D.. 1�..�6.� betN•een the Clty ot Sebostlaa� a muakipal oarposrtion e�clrtia� undcr the lswr ot the 8tate ot FbrWti �� arwtor �nd ................Beth, Ann, C�ark........................... 8005 142nd St. . . . . . . . . . . . . . . . Sehas.t.f.an, . F.1.....32958. . . . . . . . . . . . . . . . . ....................................................................... ......................... ............................................ otthe County ot . . . Ind ian R;iver ....... .. ............... �n•l 8tste of ...... Florida . , ................. ..... , ............. u (irantee� WITNE888TH� That ti�e Grantor for and in conudaration of tho rum of s....15D..OD . .............. to it in hand paid, tha reoeipt whereof is herewith ao- knowled�ed. does by thL intttuipeat �rsnt� bar�ain� �ell, ratafe� aonvey and oonfirm unto tha Gtsntee ,.��', ,, heirs, lepl repzetenta�iva and a�n� the follawL� property dtusted in 3eba�tian� [ndian River County, Fiorida. tawit: All of Lot(s) ., Z5, ., Bbck� .. 4�. .. , UNIT ,,?, ,Add :,..� of Sobaatian munidpal oemetery as per Plat Numbar 1 thoroof lreoordod in Pht Book 2, at page 65 of tha pubHc ncords in tha of8co of the Clerk of tha Circuit Court of St. Lude County of FbrWa; taW land now lyingand bein� in lndian Rivar County, Fbrida To Have and to HoW the aamo forovor; pmvidad that aaid proporty ehall be urad alely and exclusivoly for the inurment of the humat► doad and shall be used, kept end maintained at all times in accordancx wlth the ruk� �nd ro�ulatbas� ordinancet and resolutiom of tho City of Sebaatian, Flotida, hereto- fore. now and horeaftar adoptod or provlded for tho government and operation o�f �aid cemetery. The conditions, rertrictions and requireihents contained in thla instrument shall be covenanta running with tt►e land. In the evant of the failuce of the ownor of any pcoperty eituated wlthin eaid cert�tery to ob- sorve and comply with auch rules, rogulations, reeolutiona and ordinanooa and the conditlone of the ddod of oonvoyanoe thoroof then the titb of such ownr in and to said property ahaU tarminate and the same shall revert to the City of Sebsatian, Florida. IN WITNESS WHEREOF, The said party of the fust part has caused this instrument to be executad ln itt aame and on ite bohalf by ltt blsyor and attested by ita City Cleck and its wrporate aeal to be hereto affixed, the day and year firat above writton. Att ...�'7�:.`."r"�:'•�/..�:.a!�... � Clty Aerk ^�� ii�nrd, 9ealed and Ttelive�cd � ln tbe n�e ofi ..��.......�s��iY...... . .. . . .... ��' . ..' . ........... . . . . .............. G�� STATE OF FIARIDA COUNTY OF INDIAN A1VER CITY OF SEIiABTIAN, +LOiiIDA 8j........ .5..�� •.i�1�.....��• y ��`±�*. .� /'- _ -- � J ` � i f-- � . .. ^ . '� . % ' f� �� . : � .v' �� ' !'✓ � � ^ ` ' , ^' " = _ R �A � � ` �\�,'t\\\\\1��`� I HE1tEBY CESTIFY.17at on thla ........231'd..........d�y ot ......�Id.RU.�F.� ...........................t......., 1i.8.�. belore u►e per000ally appesred ......�-�?1.��.�a.SheF ................................ . �nd ...D�bRldb..C....Krae9e.S........... rap�xtively Msyor end City Cle�k o! the Clty o! 8ebutian� • munMipa) corporatfon under the 4wo ot tbe State ot Flo�lda to me kno�rn to br the ladlvidualr und ofttcera de�crfbal ln sad who a�ecuted tbe tote�oln� co�vey�ace to ............ . 8.E+,��:.�I1.,�}..�'r�.� �'�t.................................................................................................... .......................... ........ .................. snd �ever�ily nckoowled�ed the executlon theeeof to be thelr ttee act �nd deed ' u ruch alT�srs d�ttc�nto duly, ruthorlsedi snd tb�t tAe Ottkla! �wl oI M/d coepor�tion b duly atflsed thereto. wd tbe uld conteyanee Ir thc .�et -�nd��der.vl o1�Ndd c�rporstbn. W1TNE89 my d�oatun �ud ot[Ici�l �ta! at 8ebutl�n. !p tee Couaty ot Jadl�n Rlver and 8tate ot Fbrlda. thje dar �nd �ae lost afus�d.� - � _ ` Nob Pu State�... . .................... 1[y comolwioo �pira �� . �ite of F�orda �IAy Commission Expiros /yp, ,�, �gg� bnd�d lAru iror f�M • I�u�nacy. Ip�. � . ._ . / L.J � THE SEBASTTAN CEMETERY City of Sebastian 5ebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: p � ��_ �� / d 6 V FROM: � o.�� ,,,c�� _ � . . � I � �,._: ... �' ..� Ibllars (� /S O• Q � ) on this�3'� day of , l9 �L fpr the purchase of the followinq described Cemetery I.ot( upon the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)!1 /3 B1ockN �,/Q Unit# /, Qdo(_ � � Purchase Price � ' tT �^_ � mllars (s /SG •� b 1 Terms and' conditions of sa1e: .�p� `,x,Cf�c,(.L This contract sha11 be binding upon both parties, the seller and the p�rchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and canditions stated in the foregoing instrument: i � / i //_-�•/ �: / 1_j . %' / ' � �� The City of Sebastian agrees to se11 the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrurr�ent. Witness Ci ty, of i an �l��t.c�Q.G.�a'�C'c,' �� '�... .�9-r� ��,,�..c�., � � �? �� <�° �, � .: . c,r � tJ�wv�,.�,�. � PlARIDA D� OF �1`�.1� .St2t. AF A. (Type or Print) 1. Name of First Deceased Beth 2. Place of Death Ci: County Indian River 3. Name of Medical Certifier I. Basil Keller, M. D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Home 5. Check Appro- priate Box � /S � ° F da, Department of Health, �tal Stattstics ,� /�d 3 N FOR BURIAL — TRANSIT PERMIT • �//� Middle Last DATE Month Day Year OF Ann Clark DEATH Feb. 13 1998 own or Location Name of (If neither, give street address) Hosp. or • Vero Beach �"S�' indian River Memorial Hospital 25 W. New Haven Avenue Address 1623 N. Central Ave. Sebastian, FI a❑ �e medical certification has been completed and *his application. Fla. Lic. 1228 Phone Number #B, Melbourne, FI 569-641 �g. No. Phone Number (Area Code) 561-588-1000 completed ce�tificate of death accompanies b Denise was contacted on Z� � 6� 98 within 72 hours after death. He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Keller will complete and sign the medical certification of cau�e of death. �� was contacted on . He/she verified that , Medical Examiner, will complete and sign the medical certification. 6• Place of Sebastian Cemet�ry state cemetery/ • Removal Final Disposition: c matory - na / nty: Ind'lan Rlver from state Donation �• Funeral Director/ i ure F.E. No./Reg. No. Date Signed a'""'�'�'�p� . 1862 2/ 13 / 98 B. BURIAL — TRANSIT PERMIT � Permission is hereb Permit Na ��8-98-0077 y grantec 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 withir� the normal time Iimit. If the certificate cannot be filed within this extended time limit, a"Funerail Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filirg the death certificate repuested. � �� Subregistrar Signature Date a Date Certific t Issued: oZ l3 9 o Due: :�• l y 4 �• 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 arry of the abo�re methods. A waiting period of 48 hours after death is required for all cremations. � CEMETERY OR CREMATORY Methods of Disposition: Place of Disposition �.BURIAL ❑ STORAGE Date of Disposition / 8 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person-in-Charge ) _„��s� J� This permit must be endorsed by the Secton or person-in-charge (or by the Funeral DirectoNDirect Disposer when thene is no Sexton) and returned within 10 days to the local County Health Department in the County where disposition occurred. OH 326. 10/98 (R�plaess HRS Form 328 whieh may bs usad) (Sloek Numb�r: 5740-000-0326-2) STATE OF FLORIDA D TMENT OF HEALTH & REHABILITATI�RVICES VITAL STATISTICS APPLICATION FOR BURIAL—TRANSIT PERNIIT � /S � y� U �� A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Clark �F Jan. 23, 1986 Kristopher Ryan DEATH 2. Place of Death City, Town or Location - Name of (lf neither, give street address) County Hosp. or Indian River Memorial Hospital Indian River Vero Beach Inst. 3. Name of Medical [�Physician Address Certifier Heidi Marie McNaney, M.D. ❑ Medical Examiner 2300 Sth Avenue Vero Beach Fla. 4. Funeral Home/ Name Address ��c Pottinger & Son Funeral Home 1200 S. Indian River Dr. Sebastian Florida 32958 5. Check a� The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b� „�� ,�,�,�' �'JG/�JAN��( r/Vl D� was contacted on �3 I�lshe verified that Box this death was from natural causes, th�ere was no accident nor othe external cause of death, and that ��i will complete and sign the medical certification of cause of death. �� was contacted on . He/she verified that , Medical Examiner, will comptete and sign the \J� �edical certification. Gp► �. _ �3�/O �/n. ,c.c..w( 07�,,�� 6. Fune�al DireLtor/ Direc{ Disposer B. Signature Fla. Lic. No./Reg. No. � BURIAL—TRANSIT PERMIT 759- 640 ,,,,, Permit No. Permission is hereby granted to dispose of this body. � A five day extension of time for filing the death certificate (exclusive of weekendsl 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 � c f ��'� 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 requi�ed for all cremations. � CEMETERY OR CREMATORY Method of Disposition: ��BURIAL � STORAGE � CREMATION � OTHER (Specify) Siynature of or Person-in This permit must be endorsed by the Sexton or person-in-charge (or and returned within 10 days to the local County Health Department in HRS Form 326, APR. 81 (replaces previous editions which may be used.) Place of Disposition Sebastian Cemet�ry Date of Disposition Ja,n. 24� 1986 Deborah C. KraQes, City Clerk �ie Funeral G�rector/Direct Disposer when thkre is no Sexton) County where disposition occurred.