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Home My WebLink About2-33-01ci is a. 71 W. ii s 71 Name /� s h /✓1 A- �� , c ,� 1. r Unit 16 Block 3 Lot Date of Mark -out Date of Burial / 4/ Time S / k a,-/ Deed # 419 213 ($175.00) Dec. 2, 1980 Pid &.EmmaJean Fuller Cemetery 210 ($175.) Nova 1 A by Comma Receipt No. 2, :........ .... Dated. 9580 Fleming Grant Rd, * *350.00** Maximum No. Burial naves ...� .. Mi cco . Fl. List Price $..... .. .. . " "" Lots lO& 2, B1k 33, Unit Discount $• • * *• * *. Total area in square feet • • Fiat • • • • — y 3511:00• permitted Pid Fuller interred,lot Net Paid $ ................ . Monument perms ..................... 11113180. 2— �4- (Data above this line for City Record only) FULLER, Pid and Emma Jean Dead # 419 9580 Fleming Grant Road Micco, F1. Lots 1 and 2, Block 33, Unit 2 Pid interred 11113180 Lot 2, Block 33, Unit 2 Ffn ma- I-W der i 4cavd q f & j43 Lo 4- 1 State of Florida, Depa t of Health and Rehabilitative Services, Vit tistics •3 � /� 02 APP LIVACN FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Emma Jean Fuller OF DEATH 09/13/93 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Micco Inst. 9580 Fleming Grant Rd. 3. Name of Medical Certifier Medical Examiner Address Phone Number 200 E. Sheridan Road Robert C. Seelman. M.D. X1 Physician Melbourne Florida 32960 (407)725-4500 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 Q P &�� } 8 i & was contacted on 09,414.493- within 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 RnhPrt. r- SP _ i m n , 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. s• Place of Sebastian Cemetery In state cemetery/ Removal Final Disposition: rematory - a county: Indian River from state Donation 7. Funeral Director/ /� ignature F.E. No. /Reg.dlo. Date Signed B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -93 -0411 ❑ 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 fill the death certificate requested. Registrar or �, Date Date Certificate Subregistrar Signature Issued: Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA FBI 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. Methods of Disposition: ■ BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition 4,11 �i964 e- AA r E e t . Date of Disposition 9 // !o 4 7 a 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 Oct 87 edition which may be used) (Stock Number. 5740 - 000 - 0326 -2) CEM lax: Last Name SMALLEY Address i Address 2 City Deed # Unit # NEWCEM City of Sebastian, FL - Cemetery Lots First Name State aDate Amount 2- Block # 33 Lot Number i Interred Lot Number 2 Interred Lot Number Interred Lot Number Interred Comment SOLD BACH TO CITY 10f27/8W Comment <F >wrd <B >ack <E >dit <D >elete <N >ext <P >rev Wednesday, Aug 10, 2005 11:39 AM Zip Dte Interred Dte Interred Dte Interred Dte Interred 1 <T >aa <Esc> October 27, 1980 IV--. Roscoe Smalley U. S. R19,MMy 130 R. a #1 - Box 156 Pedricktown, N. J. 0806 .Dear Mr. nulley: Quit claim deed signed by you and notarized in _Salem, New Jersey has been received by us. As per our agreement enclosed is City..of Sebastian chec iamount n the a of $150.00 for repurchase -of cemetery lots k I and 2, Block 33, Unit 2 in Sebastian Cemetery. Accept our best regards far your happiness in New Jersey. Very truly yours, L Elizabethl- -"I d City Cl er'k E'R /rj encl: Cemetery check No. 515 Pat Flood, Jr. Mayor • I 0" PELICPN Ili City of Sebastian POST OFFICE BOX 127 ❑ SEBASTIAN, FLORIDA 32958 TELEPHONE (305) 589 -5330 October 14, 1980 Mr. Roscoe Smalley U. S. Highway 130 R. D. #1 - Box 156 Pedricktown, N. J. 08067 Dear Mr. Smalley: Enclosed is the Quit Claim Deed we discussed at Sebastian City Hall before you left Florida. it must be signed by you and two witnesses before a Notary Public. When you return the notarized document the City of Sebastian will mail you a check in the amount of $150.00 for the two cemetery lots you are selling back to the City. Very truly yours, Elizabeth Reid City Clerk ER /r j encl : Quit Claim Deed Florence L. Phelan City Clerk ��, . • October 14, 1980 W. Br>sW* Smalley U. S. sighaay 130 R. D» #I - Box 156 Pedricrktown, P. J. 0806; Mar Xr. Smalley: 8=106ed is the quit Claim Deed.. eye► ,disc urs d .At ,$*bswtiar:. , City Hall before you Zeta r1OxId&. Jt =wt.�bs _sib .by you and two witnesses before - a.NotnxV P blla. Men vcm return the notarized document the , City .nl. 8'ebastian sill mail you a check in the Amount _,of $150.00 -for -the two e ►t"y lots you are selling back to ..tba -City. very truly .yours Slisabet"h Reid .. City Clerk awl: Quit Claim Deed u oc, • QUIT -CLAIM D110 RAMCO FORM 8 • 31us f 4 t'(11W Pted, Executed this 14th day of October , A. D. 1980 , by ROSCOE SMALLEY first party, to CITY OF SEBASTIAN whose postof f ice address is P. O. Box 127, Sebastian, Florida 32958 second party: (Wherever used herein the terms "first party" and "second party" shall include singular and plural, heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporations, wherever the context so admits or requires.) VAA0 That the said first party, for and in consideration of the sum of $ , in hand paid by the said second party, the receipt whereof is hereby acknowledged, does hereby remise, re- lease and quit -claim unto the said second party forever, all the right, title, interest, Maim and demand which the said first party has in and to the following described lot, piece or parcel of land, situate, lying and being in the County of Indian River State of Florida , to -wit: Cemetery Lots 1 and 2, Block 33, Unit 2, of Sebastian Cemetery, as recorded in the Public Records. of Indian River County in Plat Book 6, page 45. TO %art and to Mold the same together with all and singular the appurtenances thereunto belonging or in anywise appertaining, and all the estate, right, title, interest, lien, equity and claim what- soever of the said first party, either in law or equity, to the only proper use, benefit and behoof of the said second party forever. ht 1011ltt- S Uhtrtnf, The said first party has signed and sealed these presents the day and year first above written. Signed, sealed and delivered in presence of: ....... . ....... ......... �//. ................ ........ ........ STATE OF ZK==X, NEW JERSEY COUNTY OF S -114 W..- t I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared ROSCOE SMALLEY to me known to be the person described in and who executed the foregoing instrument and he acknowledged before me that he executed the same. WITNESS my hand and official seal in the County a ate last aforesaid this �2 pp/ day of OCtob4?r A. D. 19 80 • ................ NOTARY PUBLIC OF NEW JERSEY Yy Commissiori Expires Dec. 22,1930 nif hutrument prepared by: Elizabeth Reid, City Clerk Add= P. O. Box 127, Sebastian, Florida 32958 I SM��i t'i iAlrLr+1 'UNIT 2, Block 33,j Lots 1, 2 '4�d / r 1