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Home My WebLink About1-34-31 Paid by CEMETERY Receipt No 391 Dated November 28 , 1984 List Price$ 300 . 00 NO. Maximum No.Eurial Spaces 2 Net Paid 300 . 00 103 0 Monument permitted Flat Lots 31 & 32 , Block Eryk Wiszwiowski #34 , Unit #1 591 Wimbrow Drive (Data above ddo Hoe for CRY Record only) Sebastian , Florida 32958 WISZNIOWSKI, Eryk DEED #1030 591 Wimbrow Drive Sebastian , Florida , 32958 Block 34 , Lots 31 and 32 , Unit 1 Stella WiszIiowski interred 11 /29 /84 2-04 31 Name E-/. y t/tf /S Z /l/ / v 4..) 5K Unit 1- Block 3 y Lot 31 Date of Mark-out 3/f CJ /! s— Date of Burial 3A,i 0 95 Time /1 0 0 el ✓F . Name of Funeral Home S /f E(A) f� Authorized by C" -. ;r yam•..•., wa... n4... .u.. .a wcw••wu, w u Wunsy Vr maim Ammer Ana Butte Of r7Orlaa, the day and year last.4forwlaid. Notary Public, State of Florida at.Larea..t State of florida My cwambWal expirat My Commission Enries Aug. 22, lye bnd.d 1 Am boy inn•inwaaa,Inc. 0 eitu of Orbastet T r e tt r * la 4 t b NO. 1 0 3 0 THIS INDENTURE MADE 'AU 28 th day of November A. D., 10 84 • between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Eryk Wisz//iowski 591 Wimbrow Drive Sebastian, Florida 32958 of the County of Indian River_ ani State of Florida as Grantee, WITNESSETHI That the Grantor for and in consideration of the sum of$ 300 . 0 0 to it In hand paid, the receipt whereof is herewith ao- knowledged,does by this instrument grant,bargain, sell,release, convey and confirm unto the Grantee his heirs,legal representatives and assigns the following property situated in Sebastian,Indian River County,Florida,to-wit: All of Lot(s)3 1 &32 Block, 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 first above written. (`� CITY OF SEBASTIAN, FLORI AtteCi ,CriC....X...) e . By)iorri0s, - City Clerk .Mayor Signed, Sealed and Delivered / . in the '1-"ence oh 1 'LA.,,- (Q¢itq seal) .. /fi%_„_.44,4, _ �f STAT OF FLORIDA , ,f COUNTY OF INDIAN RIVER *"y� ." I HEREBY CERTIFY, That on this 28 t h day of N o v e m b e r "^^"°....��'.^'''s"�1 iv.�. before are personally appeared J i m Ca 1 1 a ci h e r raid D e b o r a h C. K rages respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be `lwiindividuals.j►nd officers described In and who executed the foregoing conveyance to +�� , Eryk Wiszwiowski and severally acknowledged the execution thereof to be their free act and deed si such offleers thereunto duly authorised; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance is the a$ and deei of said corporation. WITNESS my sIgeature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year last-4torestaid. 31/Notary Public, State of Florida b Sts My comaisdon explress State of Ronda My Commission Extrriss Aug. 22, 1911 ballad TAN ray him.Insurance,Inc. State of Florida,Depart of Health and Rehabilitative Services,Vi.tatistics /3 Atip .,;2 APPLIC ON FOR BURIAL — TRANSIT PERMIT Cl A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Eryk ,Wiszniowski DEATH 03/17/1995 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. Sebastian River Medical Center 3. Name of Medical J Medical Examiner Address Phone Number Certifier Bay S . 77 4 4 t Center Suite 2 Noor Merchant, M.D. Physician Sebastian, Florida 32958 (407)589-0879 4. Name of Funeral Home/ Address Fla.Lic. No./Reg.No. Phone Number(Area Code) Direct Disposer 1623 North Central Avenue Strunk Funeral Homes, P.A. Sebastian, Fl 32958 1228 (407)562-2325 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b pays was contacted on ithin 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 Noor Merchant, M.D. 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 Sebastian Cemetery In state cemetery/ Removal Final Disposition: i cr--,.tory -nay e/ 9 ty: Indian River n from state n Donation 7. Funeral Director/ � ature F.E. No./PPG Nr1.-+ Date Signed oser L 1672 03/18/1995 B. BURIAL — TRANSIT PERMIT 1228-95-0157 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 filing the death certificate requested. Registrar or A — Date Date Certif to Subregistrar Signature y e - , `G Issued: 3-��-9 - Due: — z - s— 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 Methods of Disposition: Place of Disposition 'V3/4-5J A y ,, C f_ltA LJ LI. BURIAL ❑ STORAGE Date of Disposition 3/4 n/9,,- • ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person-in-Charge) Avia F. "� 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. FIRS Form 326,Feb 89(Replaces Oct 87 edition which may be used) (Stock Number:5740-000-0326-2) ,----.- G r w Gtl • /k s s c: ,/ r/ /77 n t. �J s 9y 4,_z�.., .7 2_,\,11.1p1, r i tr bsj) r tY OY� �k ��, 4/,-1\i, \AFt • , 1 g t, '1 yo° . 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