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Home My WebLink About1-34-16 Name Iy 12.0 E Qr u<n! unit Block -% Lot I ,t Date of Mark-out t=' /f � Date of Burial //0 S Time / 0 r. 4.• e,-'41 • Name of Funeral Home 7/i c.,,,. r Authorized by ` ' ��1 STATE OF FLORIDA / .� / 7 OARTMENT OF HEALTH & REHABILITAT•ERVICES /3 3'j/ VITAL STATISTICS APPLICATION FOR BURIAL—TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased / / OF / ,P p ��0/d � 2/Cl�� 6Gii'� DEATH ._45: 4, 2. Place of Death City, Town or Location Name of (If neither, give street address) County _ Hosp. or // ____4/C J,0 7/;,,d /e./ /-r�'U 1 5/�/`� I nst, 1.��1'`r<1 /�l�,E.E'��,[clC�d f/R7� / S 3. Name of Medical jg Physician 14-1 Address Certitier � j/e?/, /� Z //jl�f�,/� 0 Medical Examiner �?.� > ,) — /e'O .3`i�fCcl��,f1 4. Funeral Home/ T —Name Address T *- f<J/‹.-7 f-e�,<J,F,eaL - 7..es1�- �,c Je z ,*72-_-. ` .i.i,se 5. Check a 0 The medical certification has been completed and signed. A completed crf tificate of death accompanies Appro- this application. �/ ,l priate b �( y'��C�'//4 _//®1//1/tel ��( •Ll Box �'l r was contacted on �'"7'y�. He/she verified that this d ath was from natural causes, that there was no accident nor other external cause of death, and that .. /�'fr' tL ..G�lj.Q'j i ,e?. . will complete and sign the medical certification of cause of death. c Ei was contacted on . He/she verified that , Medical Examiner, will complete and sign the medical certification. . 6. Funeral Director/ ignature Fla. Lic. No./R flies. Date Signed 1114 t Os - / `/7 / -C --C� << -- 7 Z— (_c, - J) �o B. BURIAL—TRANSIT PERMIT Permit No./0•206>"ile-'23'4 Permission is hereby granted to dispose of this body. IAA 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. &gistrdr VI / Date 4 / l� Sub-Registrar Signature 'ii ..4.„, / - i�. ��!..i --- Issued-- �.''U/`' f ! 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. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition '`7S//4X-/ da?•/-:"--Cf—ty BURIAL ID STORAGE Date of Disposition_ —.../e-e:C)/= ,/o, '9'4' D CREMATION El OTHER (Sp ify) Signature of-Flex-n ) �• ' --e—r e. �zc- --- or Persil-in-Charge )_ I_ . ibg.... . 1-CO •• Krags, Ci ty C1 Prk This permit must be endorsed b, - 9e 6.n or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) I and returned within lU days to the local County Health Department in the County where disposition occurred. FIRS Form 326, APR. 81 (replaces previous editions which may be used.) - 0 (itg of Ort1aLtie ( r UitEX 1j Bet ?' NO. . 1081 THIS INDENTURE MADE This 6th day of June A. D., 1086 , between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Muriel Meguin 43.4 SW A4inCTerraee Sa,asti.an,..1'L 329:,8 of the County of Indian jliver awl State of ..F.IX ida as Grantee, WITNESSETHi That the Grantor for and in consideration of the sum of$ ....1Q9,..44 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 ..bar... heirs,legal representatives and assigns the following property situated in Sebastian,Indian River County,Florida,to wit: All of Lot(s) 16 84 l lock, ....34.. ,UNIT ...1. ,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. 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 used,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- serve 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 behalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto affixed,the day and year fast above written. IL- CITY OF SEBASTIAN, IDA 0 r '1jr• , B ,a^ �Ai A $eborah C. Krageity Clerk am- . Gene .eels M Signed, Sealed and Delivered • In the P nce of:i(? ____:_a.s.-e-fr,, ,..- Ya-t b ~OtiiN Sotl). ` „. ., i F\.,,,a _•• • . .• ..... _ „ ... . _ „ . . _ STATE OF FLORIDA COUNTY OF INDIAN RIVER r I HEREBY CERTIFY, That on this 6th day of June ; .•--- , 10.$6., before me personally appeared ..T,. ene..tiarEi S and .Deborah.C..Krages respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to roe known to be the individuals and officers described in and who executed the foregoing conveyance to Muriel Meguin and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorised; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance is the act and_seed of said corporation. WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year last-aforesaid. Note b Stao rWa mat Lar Notary !k, ga My commission expires* Notary Public, State of florida My Commission Expires Aug. 22, 1988 Loaded Thru Troy hin•Insurance,loci 4 k { :E,w 1 . MEGUIN, Muriel DEED # 1081 434 SW Azine Terrace Sebastian, FL 32958 UNIT 1 BLOCK 34 LOTS 16 & 17 Harold Meguin interred 6/10/86 r' I--••ri/G `j (... Lw' / t "4 i)TERMS • R e TTNC a M-, w w____ _.....,fre.,... • r- . . --------N.\- i i s 4 s 7 g ev. ikl" ,_ •,...et ,z • . y2 , . . . . . /\J `�W i 11 • ' a\liL". , . ■:•-•• 1 .i.21,./Irl..„.....a s f - r'' I,., J �v. , g I...VP__------- ---- . ' .4124 vi, 0 • b . . ar it, . .. \IlGt 1G 3.7 .Z 9. 1- 3r 4 % C i ' 3 l 3 v 4774 s3 WI 3� ti J 3 r' /i j c r A , � v.c ICJ, �hEu r b A R k r< �1Lr ,n, � of . �L O/� 4/ N /f eoD7MK,N �%,0 c^ i 4 r"..4.-C.-IC h J , / = <-.. e'7 e....,... / . • THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLE ED OF THE SUM OF: 26E - 14.c. 1 c' Dollars ($ 306. 60 ) FROM: / k 2 W Ul. / 3q Sig 33//u. / /1 C .5de fi1-1--'t j Ft 32 95S on this -- day of j , 19t4 for the purchase of the following described Cemetery Lot(s) upon the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)# /7 Block# 21/ Unit# Purchase Price: L.300 - C)0 Dollars($ ) Terms and'conditions of sale: ;01,. /4(-14(.. 1 CI 72 This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument.-241 City of'gebas ti an 1,-21-1)-414-a. 6. Witness r UNIT 1 DRFD #1081 BLOCK 34 LOTS 16 & 17 Muriel Meguin 434 SW Azine Terrace Sebastian, FL 32958 Harold Meguin interred 6/10/86 Paid by CEMETERY Receipt No 439 Dated June 6, 1986 NO. List Price$... QP.t Q0 Maximum No.Purial Spaces...2 Net Paid$ ...3Q 1L 0D Monument permitted.. Unit 1 � C' '�1 Muriel Meguin Block 34 434 SW Azine Terrace Lots 16 & 17 (Data above this line for City Record only) Sebastian, FL 32958