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Home My WebLink About1-26-28 ,?/ 0- .; -2 (0 r!. .,„,eQz7,;.„e 3 - . F3L . rEr s71NE /f4lKrz11 2 Poi- , $g s/1 C o P p /2'1546, P cvry L l 8$9 - /57'83 .. /1951- I a- !'?'' i `169. cREMA1�5. Ci3F- C 97� ,f,VW5 ✓-r 0 ate. i / /7, Ar, /2° / .,...43 ,,i,10 7,- ~ .57U/vs, ST.,.4l,P` 5T�nt,E . ' 6 1/'@- 1� ��516 )) ,vocttic‘?- of 2? 23 . i P / /fit,. 1 NI i V, ki �L(� �QrG� I�'�` , ` ` ` < p1, Sp1:A 5AlD I5O•1.b i �. 4L 31 33 .t 2n ..�� .3r �C, v. .5? 31r 4 V''‘- � ` i G r( i /:1 t. '1) / i- / ; A/ ;/ - 1 i i ryi 11 LI Ni IT btie ' i # i I . , I 1 I Name Oh ec: Unit Block Lot } Date of Mark-out it ..2/-4 / U r Time ,�C Date of Burial Name of Funeral Home Authorized by j14- 7°)11'21- 11 1-24193 Lo-I-c2 `BI o _,c ,0 a I • FRS State of Florida,Departmen of Health and Rehabilitative Services, Vital St tistics APPLICAT OR BURIAL — TRANSIT PERMIT ,;2-6 A... (Type or Print) (-://' 1. Name of First Middle Last DATE Month Day Year Deceased John Chester wheeler OF DEATH Nov. 14, 1993 2. Place of Death City,Town or Location Name of (If neither, give street address) County Hosp.or Inst. Indian River Vero Bparh VPrr RPar'h tarp rent-Pr 3. Name of Medical _J Medical Examiner Address Phone Number Certifier 777 37th St. Hal Brown, M.D. X1 Physician Vero Beach, Fl. 32960 (4 7)567-4621 4. Name of Funeral Home/ Address 20th St. - Fla.Lic.No./Reg.No. Phone Number(Area Code) Direct Disposer Indian River Cremations, Inc. Vero Beach, Fl. 32966 KB0000166 (407)234-5961 5. Check a [ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- . this application. priate Box b ❑ was contacted on 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 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. 6. Place of � In state cemetery/ Gulf Cremations Removal Final Disposition: I gl crem ory - name/countypalm Beach County Ti from state n Donation '• Funeral Director/ Sign ure r F.E. No./Reg. No. Date Signed Direct Disposer c, .%) - ,.-z --% KA0000235 11-16-93 3 BURIAL — TRANSIT PERMIT 195-93-160 Permit No. Permission is hereby granted 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 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 filin e death certifi�te requested. . Registrar or . /, Date ` Date Certificate Subregistrar Signature G ' ��G SILLeye Issued: f 7'� '/ 3 Due: AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA Cremation Authorization L- No. -9.3. 9%/AI Signature ,Medical Examiner Date or Medical Examiner, PrPdPrirk Hnhin, M.T1- , gave authorization by telephone to Pa11.1 rootirvlge — Funeral Director/Direct Disposer. Date 11-16-c)1 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 Methods of Disposition: Place of Disposition 6 Z.,//46/..a y C-,e Mvl /EE y ❑ BURIAL ❑ STORAGE Date of Disposition ///2 y/i. 3, • •CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person-in-Charge) 71 - c-)'(. • 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. . -IRS Form 326,Feb 89(Replaces Oct 87 edition which may be used) Stock Number:5740-000-0326-2) i • r . . - - & .. ' . ettti tr....0chasitatt .. 111)242 . . _ . . • ... N. . . R6, - (1.1rintterg 13 ,... tgb OFFICIAL cCO 17 Obilic- - i voi ?91 THIS INDENTURE MADE Tido 18 day of Drto.r:JubcIr A D, 19 rq < 1-' between the City of Sebastian, a municipal corporation existing under the laws of the State of Florid as Grantor, nd . . . . • • , . 1.7:clunr T .nnd/or .F.L.AP.../a.. .C1cInp ■ • . of the County of ...Indi fan..111m:1r and State of F1grj,c1r,i as 'Grantee, WITNESSETH: - • --37 ,...S That C. • . . at the Grantor for and In consideration of the sum of $ s .' to it In hand paid, the receipt whereof Is herewith acknowledged,does by this Instrument grant,bargain,sell,-release, convey and confirm unto the Grantee heirs, legal representatives and assigns the following property situated in Sebastian, Indian Rivet County, Florida, to-wit: • ST ..1/ti.of Lot .2..111.k....2.6. in Section B of Sebastian municipal cemetery as per Plat Number I there- of recorded in Plat Book 2, at page SS of the public records in the office of the Clerk of the arenit Court of St. Lucie County of Florida. To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the Interment of the dead and shall be used, kept and maintained at all times In accordance with the rules and regulations, ordinances and resolutions of the City of Sebaitlii, FlOildil, heiretofore, now and hereafter adopted or provided for the government and operation of said ceme- tery. 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 observe and comply with such rules, regulations, resolutions and ordinances and the conditions of the deed 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 be • hnif 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, FLORIDA • ' • . / . ,.... ___, ,/•"' t \ t• ( / ,',/ .1 1 ' ./ , • - - e.. t ' j7G Attest: ' - ''..- '•r---: '----- . / I. ' ''----------H Fl.:04rD4',..,-17, . •-- Mayor -IF r-11";11"..-D.r.A . , • • • •• ) : City Clerk ••, -", . '• • ,, Signkt, Sealed and Lieny'ered 1) IP°, "Ttr ' in thi: Presence of: ,: : I' ..,A i . .Of' Vr.• ', t ..' : I 0 Ap.10.419.• 1 , * , I '',-8.,(111 ,.," 1 (eittj Atiti) . '4,4 4 0,"7i.A. i '''' . e. ; 1 e‘:: , -.•'1! ! N ,,,o'44 .t...;/‘ - • ., .• *010$1 .(I NT••;• * • • , • • STATE OF P1.013IDA 67 COUNTY OP INDIAN RIVER I HERElkir.'6ERTIPY,Tha thip f/y5t,( 7:ay of , )• , .... , hi•forr Inc persOnally appeared ----' 6 t cif (A) .,‘„/176/./ (.- and ...‘1,0:-C.....e. respectively Mayor and City Cl of the City of Sebastian, a municipa cor ration under the taws- the State of Florida to me known to be the iniliv'iduals and officers described In and who executed the fore I g conveyance to . - A ..-/ . •• t.-) ' l : .) • ..• ' •i t •, ', ;; • ./. „ . and severally acknowledged the execution thereof to be t‘Sir free act and deed lis such officers thereunto duly authorized; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance k the net and deed of said corporation. WITNF.SS my signature and official seal at Sebastian, in the County'ol In River ' State of ylorlda, the day and year last aforesaid. . i ./.. •••• • ..‘. . ..-66‘q4.-/-e N••a.riPultile-, at of-Triciiit La-rge. ....f YjCcmIIdsRIen expires! '; •'- :a 4.1r7 111.,y Cc 1-.r.,:•- : : : 7.. ' .1