HomeMy WebLinkAbout4-48-18/ [.ut p~ice $. 2,00.4~0 ....... /~amum No. mum Sm~e ...... 2. ..........
Net Paid $ . ./4.0.0 ..OD. ....... Monument permitted .... .~,a~., ............
Marjorie & James Poole
564 S.W. Caravan Terr.
Sebastian, Fl. 32958 .(Dn~ nbove mm lian for CI~ R~eerd o~)
NO.
1117
Lots 1'7 & 18,BLK.48,UN.4
Willie Poole Int.6/5/87
lItt of ehasIiau
( emelery eeh
NO.
1117
between the City of Seb~fle~ a m~lcip~ ee~orat~n exlat~g oder the ~ws of tbo State o! Finrld~ as Gruner ~d
JAMES AND ~ARJORIE P00LE
................... ~.~..~:.~:..~.9~.~.~...~p.~,..~pr~a:...~9.~ .........................
of the Connty of ...... I.n..d&~D..Riv.er .................. ..-I State of ..... ~lar.ida .....................................
la Grantee, WITNF. S.qETH~
That the Grantor for and in consideration of the sum of $ . ?..0. O.m O.O ............... to ti in hand paid. the receipt whereof is herewith ac-
knowledgcd, does by this instrument grant, bargain, sell, release, convey and conf'~m unto the Grantee . ~J~i~ heirs, legal rep~esentative~ and assigns
the following property situated in Sebastian, Indian ~ County. Flora, to-wit:
A~ oe to,s~l.7. ::..1.S., B~, ?..S. ..... ~ ... i ......... of Seh~ ~ap~ ~m,,e~ ~s p,, eat ~umber ~ ~oe ~co,~ed ~ P~t
Book 2, at pege 65 of the public records in the office of the Clerk of tho Circuit Court of St. Luci~ County of Florida; said land now lying and being
in Indian River County, Florida.
To Have and to Hoid the same forever; provided that said property ~hul! bo used solely and exclusively for tho interment of the human dead and shall
be used, kept and maintained at all times in accordance with th~ rules and regulations, ordinances and resolutions of thc City of Sebastian, Florida. hereto-
fore, now and hereefter adopted or provided for tho goverumant and operation of said cemetery. Tho conditions, msUictions and sequiremants contained
in this instrument shall bo covenants ruani~ with the land. In tho event of the failnse of the owner of any prope~y situated within said cemetery to ob-
serve and comply with iuch rules, regulations, xecointions and.ordimmces and the conditions of the deed of conveyance thereof then the title of such owner
in and to said properly shall terminate and the same shall revert to the City of Sebastian, Florida.
IN WITNESS WH]~REOF, The said party of the fiist pm has caused this instrument to be executed in its name and on its beholf by its Mayor and
attested by its City Clerk and its corporate seal to be hereto affixed, tho day and yea~ first above wtitten.
Attest~/'/~ '~'~' CRy erk ' '"'
,~igned, Scaled a~id Delivered
I~e Presence
STATE OF ~OHIDA
~UN'~ OF INDIAN ~IVER
CITY OF SEBA~TIAN,.~LO/I~ID~
Name
Unit
Lot
Date of Mark-out
Date of Burial
Name of Funeral
Authorized by
u~s.gO0,.O0 .......
NetP~d$ .AO~.~fl .......
Marjorie & James Poole
564 S.W. Caravan Terr.
Sebastian, Fl. 32958
Maximum No. Burial Spaces ...... ~, ..........
Monument pezmitted .... ,~ ;La& ............
(Data above this line for Clt~' Ib~ord only)
NO.
1ii?
Lots 17 & 18,BLK.48,UN.4
Willie Poole Int. 6/5/87
STATE OF FLORIDA
:-PARTMENT OF HEALTH & REHABILIT E SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL--TRANSIT PERIVIIT
A. {Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
WILLIE MADDOX POOLE DEATH JUNE 2, 1987
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Inst.
INDIAN RIVER VER0 BEACH VERO BEACH CARE CENTER
3. Name of Medical ~[] Physician Address
Certifier CIiAR[-7-,S RA't~Z~,Yr M~D. [] Meclical Examiner ~08 8t.h,%Vi~Ug., VERO BE~CH
4. Funeral Home/ Name Address
Direct Disposer
5. Check
Appro-
priate
Box
Funeral Director/
The medical certification has ~en completed and signed: A completed certificate of death accompanies
this application. ~
DR. ~Y was contacted on 6/2/87 . He/the verified that
this death was from natural causes, that there was no accide~t nor other external cause of death, and that
fie will complete and sign the medical certification of
cause of death.
medical certification.
was contacted on . He/she verified that
Medical Examiner, will complete and sign the
Fla. Lac. No./l~:;.
Date Signed
JUNE 3, 1987
BURIAL-TRANSIT PERMIT Permit No. 1228-87-212
Permission is hereby granted to dispose of this body.
A five day extension of tinre for tding the death cer[ibcate (exclusive of weekends) has been requested and
granted. If il cannot be filed within ~his time limit, a "Funeral Director/Direct Disposer Report" will ~ filed
w/th the L~al Registrar of the County in which dea,h occu,red.
Sub-Registrar Signatu~ ~ f ~ ~'~ Issued J~E 3~ 1987
AUTHORIZATION for CREMATION, DISSECTION or BURIAL--AT--SEA
Sigl~atu re Medical Examiner Date
o[
Medical Examiner, gave authorization by telephone to
Funeral Director/Direct Disposer. Date
Tile Medical Examiner'~ 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.
Method of DisDositloo:
[] BURIAL [] STORAGE
[] CREMATION [] OTHER (Specify)
Sigr~ature of Sexton )
o~ Person-in-Charge )
CEMETERY OR CREMATORY
Place of Disposition
Dale of Disposition
This permit must be endorsed by the Sexton or person-in-charg0 {or by the Funeral Director/Direct Disposer when thele ~s n{) Sextons}
and returned within 10 days to the local County Health Department in the Coot, tV where disposition occulred.
HRS Form 326, APR. 81
(replaces previous editions which may be used. ),.2"~'.