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TH18 1NDENTURE l[ADB 11L .......6.th.... .. ... dny ot ...November .............................. A. D, 1�.84..�
bstween lhe Clty of 8ebarWn. a municlpal corporatbn enirtin� under the lawa ot the 8t�te of Floridy �� arwto� aAd
Stanley 6 Ethe1 Ours
. . . . . . . . . . . . . . .1.�'6 �'d "77'i1i 'Cou'r't' ...... . . . . . ... . .... . . . . .. . . . . . ... ..... . ..... . . . . ... . . . . . .. . . .... . . . . .. . .................. ......
............. Sebast.ian,Florida, 32958......................................... ............................................
Indian River Florida
orthe County or ............................................. �n] st.le ot .......................................................
u Ot�n�ee„ WITN8�8BffiTH�
Tiurt the Grantor for and in conaderAtion of the sum of s, 300: 00 ,, to it in, hand paW, the reoelpt wheteof U Iurewith ao-
...............
knowbdged, dooa by thu inatrument grant, bargain, wll, relesea. convey and oonfirm unto tho Gtantea , the i r.��� �� ��e�entativa and aud�nt
the folk�win� proparty dtuatod in Sobattian, ladian River County, Florida, to�vit:
19 & 2 3 9 UNIT ,1. Ad d i t i vn�� �bastian munldpal oometery as per Plat Numbet 1 thereof naorded ln Pht
All of Lot(r) . . . . . . . � �I�odc, . . . . . . . . .
Boo� 2, at page 65 of the public recards in the ofSoe of the Clerlc of tha Circuit Court of St. Lude County of Fbrlda; wid W�d now lyin� and beln�
tn Indiau Rivor County, Florlda.
To Have and to Hold tha eamo forever; provided that eaid property thall be ueed eolely and exctudvoly for the lntertnent of the human deod and �ull
be ured, kept and maintained at all time� in accordance with the ruler and re�ulatbna. ordinance� and rewlutlon� of the Clty of Sebattlan, Florida, hereta
fore, now and hereaPter adopted or provlded foc the �overnment and operAtion of wld cematery. The oondltionr, certrictioni rnd requlremenb contained
in this lnrttument �hall be covenant� runnlny wlth the lend. In the event of the failure oP the owner of wny propetty dtuated withln alA ametery to ob-
•erve and comply wlth auch rulea� reguladonti reNOluUons and ordiiwnae and tho condltione of the dded of conveyance thereof tl►en the tltb oP wch owner
In and to �eid property et�all terminate and the �ame rhall revort to the Clty of Sebartian, Florida.
IN WITNESS W}iEREOF, The wid party of tho fltst part has caueed thia inetrument to be oxacuted ln iU name and on !t� behalf by lt� Mayor and
atteated by itr City Clerk and ite oorpotate �eal to be horeto effixod, the day and yoar firat above written.
AtteQt� . `��:�,-!1..../..�'.��.�-c,-.!C:� ...
Clty Q�rk �����
�
Ri�nrd, 9ealed und Dellvercd
la the Prnenee o/i
...�� ........... .. ,.....................
.��!�. .4/ . . . '. . . . . . .l'�: . . '.1,��'S-ti4( . . . . . . . . . . . . . . . .
CITY OF BI�aABTIAN� FIAR A
B� .... .. .�yoi.. ...................
��� ���
BTATE OF FLORIDA
COUNTY OF 1NDIAN AIVER
I HE1tEBY CEATIFY� T6at on tbb .. 6.th .... . .. . . . . . .. .d�y ot . . IVovem��,r ...... .. .............. ..... .. . . .... � 1�l99. ,
belure me perron�lly appeared ......Jim Gallagher ............ ..................... and . D�,bQr�1�..C�. K�ag�r�.
. ...........
re�p�ctivdy lNayor �nd Clty Clerk o! the Clt� ot 8ebutl�n� � municlpal corpor�tlon under tM bw� of t11p 8tste Ot FIo� to ta� 1[aOwO
to br tlwe Ind►viduwl� rnd otttcer� drerlad fo sad who a�eeutad the lore�oln� co��eyNnp ta
Stanley 6 Ethe1 Ours
......... <<��.»....,.4: . ................................................................................................................
; ._ .
....��.L•`,•:......�.,..., ............................... and severally acicnowled�ed the e:ceutlon thereot to be thelr tree set and deed
a� ptcl��ticerc tl�ereuato du�y authorlsed� �ud that tlk Otfk[d reai of aW corpot�tbn f� duly �tpxed tbenb, �nd tbe vtd con�eywet
b S�he':ttct.,�Q! do�tti' d NI� Corp4ratJoa.
� W1TNE89 my dgp�tqn and otfkW �eal at geputisn. W tbe County ot Indl�n Alver ud Htate ot FbrkL, the dq and �a�r
t� dorra�ki.
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�� . Nob PuWl�e� 8tate ot D'lorlda st Iwtp.
Yy ���°° �D��� Notuy Public, State of flaid�
My Commission Expires Auq. 22, 1988
Wad�d Thru Lor hin - la+uwnc�. Inc.
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QState of Flo�ida, Departme ealth and Rehabilitative Services, Vi#al S�cs
APPLICATIOI�FOR BURIAL — TRANSIT PERMIT
� i y, � �'
� �3 9
� ��
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased Stanley G. Ours DEATH O1/27/1993
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst.
HU�AIIA HOQni tstl -.S`r�haat i an
3. Name of Medical
Certifier
Nasir Rizwi, M.D.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Homes, P.A.
5. Check
Appro-
priate
Box
Address
North
Address
13865 U.S. 1
Sebastian Florida 32
Fla. Lic. No./Reg.
Phone Number
Phone Number (Area Code)
a❑ The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b�( peggX was contacted on �+ ��o �+ n�hin 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 Nas i r R i 2w i � M. n_ will complete
and sign the medical certification of cause of death.
c❑ was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medical certification.
I 6• Place of Sebastian Cemeterq In state cemeter / Removal
Final Oisposition: /�,�;�ematory - /counry: Indian River n from state (—j Donation
I �• Funeral Director/
Ritect.9isne�ser'
I
F.E.
Date
g. BURIAL — TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-93-0040
❑ 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 within the normal time limit. If the certificate cannot be filed within this extended time limit, a"Funeral Director/Direct
Disposer Report" will be filed with the Local Registrar of the County in which death occurred.
❑ No extension of time for fili g the death certificate
Registrar or ��
Subregistrar Signature
Signature
or
Date /_ �J' .�j� Date Certificate
Issued: � Due:
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
, Medical Examiner Date
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.
Methods of Disposition:
❑ BURIAL
❑ CREMATION
Signature of Sexton )
or Person-in-Charge )
❑ STORAGE
❑ OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition �� E a a_, i, K� C�F M E TF R Y
Date of Disposition a °
I 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 HRS County Public Health Unit in the County where disposition occurred.
HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used)
;Stock Number: 5740-000-0326-2)
°'t CEM �
Index:RECORD #
Last Name Ours
Address 1
Address 2
City
Deed #
Unit #
t Number
t Number
t Number
t Number
City of Sebastian, FL - Cemetery Lots
1022 Date
i-A Block #
19 Interred
20 Interred
Interred
Interred
Monday, Dec 27, 2004 09:51 AM
First Hame Stanley & Ethel
State �ip
11-06-84 pmaunt $300
39
MORRIS, SHIRLEY tCREMAINS)
Stanley Ours CUet}
Record:
Dte Interred 12-17-88
Dte Interred 01-30-93
Dte Interred
Dte Interred
)elete CN>ext CP>re� <R>e-search <L>abel
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