HomeMy WebLinkAbout4-40-30
Lots 29, 30
, ,ck 40
Unit 4
NO.
. . 659 2/11/91
Paid by CEMETERY Receipt No..............'... Dated..............................
List Price $.. ~?Q ...QR...... Maximum No. Burial Spaces.................'
Net Paid $ .. f!?q : .QR . . . . . . Monument permitted .. . .. . . ..,. . . . '.' . . . . . . . .
Mrs. Dunham
Franklin Duhham interred 2/9/91 Lot 29 6120 River Run Drive
(Data above thla line lor City Reeord only) Sebastian, Fl. 32958
1113
cnitll of l'rbustiuu
OJrmrtrry
ilrrb
NO.
'l.1313
THIS INDENTURB MADB 'J1IJa ..... J. L t.n.. .. .. ,... day 01 .... .f.~p;r::\l:t;l.:r;y'.. ....... ................. A. D.. 19.9J...
between lhe City 01 SebutJan, a municipal corporation exlltln, under the lawI 01 the State 01 Florida, al Grantor and
. . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. , . . M:r:-.l?, . . E:r:-.l;\nk)'i.Q. . P.'\l:I)..l)~Pl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6120 River Run Drive 8
. .... ........................................ ... Se.b.~~ t.i.l;\n".. .f.1Qr.:.i.Q..~.. ~.~.9.~ ............................................
01 the County 01 ......~~~~.~n...~~.y~~.................. an:1 State of .....~~~F~~~.....................................
u Grantee, WITNBSSBTH.
That the Grantor for and in consideration of the sum of $ ..~ ?Q... 9~ . . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargam, sell, release, convey and conrum unto the Grantee .... P.~ h heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s) .~9. ,1lQBlock, .. !+.9... ,UNIT...~......... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at page 65 of the public records in theofOce 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 aU 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'j.the. goverriment and operation of said cemetery. The conditions, restrIctions and requirements contained
in this instrument shall be covenants runninl 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.
AlI",~~Jn..{)(;j~
~. !.- City Clerk
CITY OF SEBASTIAN, FLORIDA
.,...... So"'" omd ","..m! :p
e P7~............ ...........
;a~j~~~............
ST A'fE OF FLORIDA
By ~.C;:~........r...
Ma/
(QIitu "I!al)
'1
...-
Name Ph y L L'!.s C t DUlV hl1 M
4
L;. X 8/
3 hR5
Unit
Block
l,/ 0
Lot
30
Date of Mark-out
]-J,6-04
Date of Burial 73 - [):~r--';;;:)O 4
/' /
,/ /)4//.("'" ....,....., t.<:.
Name of Fu,...' H"~e f V / 8. (j N . <;)
////~/> " ,~;/ fl(' ,
Authorized by ~'C'"_' " , ,.".,/. , /) ("'-":..-;:.':.c<".,;.,,,t',,,,.,,,.;-.
Time
1;J
"'-t
("~ /':' f~' ,0/1 .
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- -~ ---- - ~ ---- .------ -- ---- - ---- - - "---. -.-
CITY OF ,SEBASTIAN
CITY CLERK'S OFFICE t' 2 6 7 0
RECEIPT
...~.I~ if;.(...~d.O"". ~./7
../~..u~:;-r4t2.<Ji-. ~.....~
. ~ Amount Paid
1001 208001 Sales Tax
1501322900 Garage Sales
1501 341920 Coples/Bld Specs.
1501 341910 LOCICode of Ordinances
1501 341930 Election QuaUfylng Fees
1010343800 Cemetery Lots
LotINlche ~ (l . Block ~6 Unlt~
1501 343805 Cemelely Fees a. diwA.. ~-:;,()
PAt""~
O -/
Total PaIcl,?t!&.,iJ
.R.
Initials
White - Dept. of Origin. Yellow - flnlnce · Plnie . Appllcent
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Secllrit enhanced',document. See bile,A: or. detail,.
STRUNK FUNERAL HOMES~ .P~A~
,CASH ADVANCE ACCOUNT;.$EBASnAN
. 918'17'1liST.
VERO BEACH. F\.; 32960
PH. 581__-2325
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cg;JI~'-~t r~ ·
IIlNB'Ee~-
ladlU Ilim' NlllonaIllIu' -....-.-
I FOR ~,,~,:::O;;~:/. Olo~.?cit~~~-~
PAY
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s...j"'l 4L-
4243
DATE
~\2.c.\l)c.r
83-1205/870
01'
I $ .,~. cOO
DOLLARS ~ ==:-
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
f-~~ -3d
~
FLORIDA DEPARTMENT OF
2. Place of Death
County
I ndian River
3. Name of Medical
Certifier Richard Cunningham. D.O.
Medical Examiner Physician
t Name of Funeral Home/liireet BisJ'emil Address
Establishment
Strunk Funeral Home
5. Check a. 0
Appropriate
Box
Phyllis
City, Town or Location
C.
Dunham
Date
of
Death
(If neither, give street address)
Year
!I..
I. Name of
Deceased
(TYPE)
First
Middle
Last
L.,
March
26
2004
Vero Beach
Name of
Hosp. or
Inst. VNA Hos ice House
Address
2000 38th Avenue
Vero Beach. FL
Phone Number
772-7911-2227
1623 N. Central Ave.
Sebastian. FL
Fla. Lic. No.lReg. No. Phone No. (Area Code)
1228
772-589-1000
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
b. rtJ
Shelly was contacted on 3/26/04
He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death,
and that Dr. Cunningham will complete and sign the medical
certification of cause of death wit 'n 72 hours,
c.D
was contacted on
He/she verified that
, Medical Examiner, will complete and sign the
5. Funeral Director/
Qjp:a"t niC!p^eAr
Date Signed
3/26/011
P . N 1228-011-01111
Permission is hereby granted to dispose of this body. ermlt o.
o A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within
72 hours.
ONo extension of time for filing the death certificate has been requested.
BURIAL - TRANSIT PERMIT
3,
....~:J,Llal ur
Subregistrar Signature
Date
Issued: 3/26/011
Date Certificate
Due: 3/31/011
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT -SEA
Approval Number:
Date
Medical Examiner, . gave authorization by telephone to
Funeral DirectorlDirect 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.
Methot! of Disposition:
CEMETERY OR CREMATORY
Place of Disposition
Sebastian Cemetery
),
[!]eURIAL
DCREMATION
Signature of Sexton
or Person-in-Charge
o STORAGE
Date of Disposition
3h?/o~
DOTHER (Specify)
} -1',0 1 - .!(~~?
rhis 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
vithin 10 days to the local County Health Departmentin the county where disposition occurred.
IH 326. 8/97 (Obsoletes all previous editions}
51oc1< Number 5740-000-0326-2)
Distribution: lNhite: Cemetery or Cremetory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar