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Home My WebLink About4-31-32w ------ Paid by CEMETERY R.celpt No" ,.. . List Price S . .1..300..0.0.., 1,300.00 Net Paid S ......,..,........ Anne M. Bridges 3/17/94 Nich s 31 ...... Dat.d,...,...........,.....,.. 'B'lbck 31 Ma"imum No. Burial Spaces, . . . , . . . . , . II n.i t 4 12 NO. Monum.nt permitted. . . . , . .. . .. .. . .. .. . . , . . '11454 (Data aboy. this IIn. for City Reeord only) Cltitll of &thastian OItmtltry I ttb 1454 NO. 17th MArch 94 A. D~ I........ THIS INDENTURE MADE TItJa day of het.....n 'h. City of S.bastlan, a municipal corporation ""Istlnl und.r the laws of the Stat. of Florid.. al Grantor and ............ .............. .................... .tgr~'E"=~l.n~~~t...................... .............. ................ ...... ....... ............... ....................... .., .Sebas.tian,. . Elorida.. .3~9.56...................... ..................... of the County of.....JI?-~~~.I?-..~~.y.~~................ an:1 Stat. of ....~.~!>~~.~.~~~................................... u Grantee, WITNESSEm, That the Grantor for and in conllid.ratlon of the sum of $ ....,~,!.~ ?~ : .~~ .. . , . . . . to it ~ hand paid, the receipt wher.of II h.rewlth ac>- knowledged, does by this instrument grant. bllr8.m. seD. r.I..... convey and confmn unto the Grant.. ...7?:... heirs, legal repr.sentatlves and asslgnl the foUowbIK JItOperty sltUllted In Sebastian. Indian River County. Florida. to-wlt: Nicne~I&J2 31 4 AD of ~ . . . , , '.' . Block, , . . , . . .. ,UNIT ..,.......... ,oC Sebastian municipal cem.tery al per Plat Number 1 thereoC recorded In Plat Book 2. at page 65 of the pubDc records In the omce of the Clerk of the Circuit Court of St. Lucl. County of Florida; said land now lying and b.i.. in Indian River County. Florida. To Hav. and to Hold the sam. forever; provided that salel property shan be ueed 101.ly and ."clusively for the Interment of the human dead and shall be used, k.pt and maintained at aD tlm'lln accordance with the rul'l and r....latlons, ordinances and resolutions of the City of S.bastlan, Florida, her.to- for., now and h....ner adopted or provided for the Ilovernment and operation of said cemetery. The conditions, restrictions and requir.m.nts contained In this liIstrum.nt shaD b. co~nants runninll with the land. In the event of the failure of the own.r of any property sltUllted within said cemet.ry to ob- serve and comply with iuch rules, regulatlonl, resolutlonl and ,ordlnancel and the condltlonl of the M.d of conveyance thereof then the title of such owner In and to said property shaD termlnat. and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF. The said party of the fIrSt part has caused thlllnstrument to b. ."ecuted In Itlname and on Its behalf by It I Mayor and att.sted by its City Clerk and its corporat. seal to b. her.to afftxed. the day and year first above written. ..~..~'11~-p c~,o;~~~ Mayor Rlgned. Seal.d und D.llvered In the P ne. 0" ~ . . .... ..... ............... .~.... .~.... (QIitu "'.al) TATE OF FI.ORIDA COl'NTY OF INDIAN RIVER 17th March 94 IIIEnEUY CERTIFY. That on thla ........................day of .................................................... I...... Arthur L. Firtion Kathryn M. O'Halloran b.fore m. personally app.ared ........................................................... and ....................................... resJlf'<llv.ly Mayor and City Clerk of the City of Sebaltlan, a munlel,.al corporation und.. the la...s of the State of Florida to me known 10 be the Indh'iduull ""d omer.. d.scrlbed In ond who .".eutl'" th. 'ure'golng eURv.yonce to .............. ........ ......... ............. :I\~.J:?~. .~: ..~~.~.~~~~...... ................................................ .......... . . . . . . . . . . . . .. .. .. .. . . .. . . . . . . . . .. . . .. .. .. .. .. . . .. . . .. .. and severally ac"nowledg,"" the e"..utlon thereof to be th.lr fr.e aet and deed .. snch ortlee.. thereu"to duly uulhorlzed; and that the Omelal ..,ul of said cnrporatlon I. duly affixed th.reto. and the said eunv.yanee II the lIet and d.ed of said eorporatlon. WITNESS my Ilgnature and offlelal ...1 at Sebaltlan, In the lalt afor""ald. 'i\iii'~ I.JtI)A M. 8AU..EY f./JiJ.'~.\ MY COMMISSION , CC334817 EXPlIIfS '''',6' i June 18 ll1!l4 '1,'l.iir.Sr.~ 1IO'~-JTROYfo._.II<<l. Linda M. Galley ~ / Name ':-~~Dbe (-<,:~- \'l, 't:,)f:.. I i \ '':'1 ':5 '-I ( (' I:, ~ "I,<'T"':' ~:. ,:::3 Unit'" Block .3 t '" J'~"'" i,~ \,f f.. '>/ 1\i'i:,~" ,;:or Date of Mark-out .3 - ;Jf' -'7 .; Date of Burial 3-:lI3-'1Y Time j;O{) P'i"!!l- r' ' J~'I' Name of Funer~rHome ~,. C~j('./ ,;) , Authorized b;~a, ",' j ,1::' / '"~_ ,.~~,r ~,.' ' r;4A.// ! 7 ';I /:'~, ''','~ ~.b,'" .,.i~ ' .' .. . _"" .' /{-,k;'I~l .... . ! I i J AI V;:;( / A. -:? '" /f" , v' voL.l(j ,~ rmJ State of Florida, Depart.of Health and Rehabilitative Services, Vi4tistics APPUCATlON FOR BURIAL - TRANSIT PERMIT {j3/ !/~ A. 1. Name of Deceased (Type or Print) First Robert Middle Williamson Last Bridges DATE OF DEATH Month Day Year Mar. 19, 1994 Roseland Name of (If neither, give street address) Hosp. or . InsSebastian River Medlca1 Center 2. Place of Death County Indian River City, Town or Location 3. Name of Medical Certifier Muhamnad Siddiqui, 4. Name of Funeral Home/ Direct Disposef Indian River 5. Check Appro- priate Box Medical Examiner Address Phone Number M.D. Physician Address 6604 20th St. Vero Beach, Fl. ~fe~~~f~~,Br~'32976 407 664-4349 Fla. Uc. No./Reg. No. Phone Number (Area Code) Cremations, Inc. a ~ The medical certification has been completed and signed. A completed certificate of death accompanies this application. 32966 KBOOO0166 407 234-5961 b 0 was contacted on within. 7 2 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 0 was contacted on . He/she verified that ,Medical Examiner. will complete and sign the 6. Place of Final Disposition: 7. Funeral Director/ Direct Disposef medical certification. In state cemetery/ Gulf Cremations crem ry - name/count)palm Beach County Sign re ~ F.E. No./Reg..No. KA0000235 Removal from state Donation Date Signed 3-20-94 B. BURIAL - TRANSIT PERMIT Pe 't ~95-94-046 rml NO. Permission is hereby granted to dispose of this body. o A five day extension of time for filing the death certificate (exclusive of weekends) has been fequested 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 w' the Local Registrar of the County in which death occurred. ~ No extension of time for filing death certific request . ~ Registrar Of Subregistrar Signature Date Issued: ..3 .... 2.(?.. ~~~~ Certificate C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Cremation Authorizatior .. No. {l. '14,'/9~ :3~'7~ Signature , Medical Examiner Date or Medical Examiner, Frederick Hobinr M.D... , gave authorization by telephone to ~u1 Goodridge Funeral Director/Direct Disposer. Date ':l_?' -QA , 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: o BURIAL I2l CREMATION o STORAGE o OTHER (Specify) Place of Disposition Date of Disposition .:.1e.ba,s/..e. AI t7~,..,~ l~~ -IJIJa ~ ~ I( ..:J B 17 9y I Signature of Sexton } or Person-in-Gharge } . .A.,. L.... __ . ' ('../-..1-- 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. HRS Form 326. Feb 89 (Replaces Ocl87 edition whICh may be used) (Stock Number: 5740-000-0326-21 J