HomeMy WebLinkAbout4-47-35l~aid by CEMETERY Receipt No .......................
u, ~,,i,~ s... ,2..0p, :.O.0. ..... ~im,~ No. B,,,-i, Sp,,~, .................
Net Pzid $ .../4(~0 ~0 ..... Munun~.at ~rndtted ...........; ...........
(Dats inhere thb Une for City Record only)
Lots 34 & 35 No.
31k.47, Un.4
Gregory &/or 1189
Nadia Popow
13655 ??th Tart.
Sebastian, Fl. 32958
(lliIU of i ebaslian
emelery Beei
NO,
1189
88
THIS INDENTUEE MADE %~h t5th d.y of September A.D., 19 ...... ,
of the CounW of ............ Indian. 1~i.v.~r ............ ~]] State at ..... F,l~)~.d~ ......................................
ss Gr~mt~ WITNES~RTHt
Tflat the Granto! roi aad in ~onside~atlon of the stun of $ ...... .4.0..0.: .0..0 ........... to it in hand paid, the ~c~ipt whereof is herewith a~-
knowled~ed, does by fids lostrmunnt ~-ant, bal~aih, sell release, ~onvey ~nd confirm unto the Grantee .~..h.~.~.~. heirs, legal ~ep~esentariv~s ~nd as-~ns
the followi~ property s~tuated in Sebastian, Indian River County, Florida, to-wit:
35 47
All of Lot(s) .3.4....&. , Block .......... UNIT .... .4. ........ of S~hestian munkipai cemetery as per Plat Number 1 ~here~ f ~eco~ded in Plat
Book 2, ar pa~e 65 of the publi~ records in *he offic~ of the Clark of the C/rcuit Cou~ of SL Lucia County of Florida; said land now Lying and beinS
lo Indian River County, Florida,
To Haye ~nd to Hold the nme foz~ver; p~o~dded that ~ ~op~y ~ ~u~ m~ly ~ excla~v~y for t~ hter~nt of the hu~ d~d ~d ~
be u~, ke~ ~d ~ed at ~ ~es ~ a~o~ ~ t~ m~s ~ re~tlo~ or~s and re.lotions of t~ City of Sehe~. Florida, hemW-
fore, ~w ~ he~ ~o~ o~ pro~ for t~ go~ent ~d o~a~n of ~ ~te~. The ~n~tions, re~i~ons ~ ~e~ms ~n~
~ t~s ~t ~H be ~ve~ts ~ ~ t~ ~d. In t~ c~nt of ~ f~ of ~e o~ef of ~y pfo~y ~t~ ~t~ ~ ~fy to ob-
· ~/ Clt3, Clark
~igned, Sealat and Delivered
....................
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLOEIDA
..... : .....
M~yor
Unit
"Block
Lot -~ %--
Date of Mark-out
D~te of Burial / / ~r~ V/? ~ --
Time
Net Paid $ ... 4 gO ·'0 0 ..... Monument pexmitted .......................
(Data above t~ls ~ for City Record
Lots 34 & 35
31k.47, Un.4
Gregory &/or 1189
Nadia Popow
13655 77th Terr.
Sebastian, FI.
32958
POPO~j, GREGORY AND/OR NADIA
13655 77th Tart.
Sebastian, FI. 32958
DEED NO. 1189
Lots 34 & 35
Block 47
Unit 4
State of Florida, Departr~ of Health and Rehabilitative Services, Vita~tletics
APPLICA"I=I~I FOR BURIAL -- TRANSIT PERMIT
(Type or Print)
1. Name of First Middle Last
Deceased
Gregory N. Popow
DATE Month Day
OF
DEATH 01/02/95
Year
2. Place of Death
County
Indian River
City, Town or Location
Veto Beach
3. Name of Medical
Certifier
Hal W. Brown? M.D.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Homes~ P.A.
5. Check a
Appro-
pdate
Box
Name of (ff neither, give street address)
Hosp. or I ntergrated Health Care
Inst. Service of Veto Beach
I Medical Examiner Address Phone Number
777 37th. Street
Xi~]Physician Veto Beach. Florida 32960 (407)567-4621
Address Fin. tic. No,/Rag, No,/Phone Number (Area Code)
L623 North Centra! Avenue
;ebastian~ Fl 32958 1228 K407)562-23.°.~
[] The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b~ [] . was contacted on 0!/92/95 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 th,~Ja ] W_ Rrnwn: M.D. will complete
and sign the medical certification of cause of death.
c [] was contacted on . He/she verified that
, bledical Examiner, will complete and sign the
medical certification.
/
In ~,tate.,C~emetery/
X,~ ,~m~ry - name/county: Indian River
c/~S~ F.E. No./Reg. No.
6. Place ~ebast lan Ce~ery
Final Disposition: // / /~'
7. Funeral Director/ .~ [ / ~'../..
Direct Disposer~__ ~/ ~
Removal
from state ~'~ Donation
Date Signed
Ol103/q~
B. BURIAL -- TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit N~,228-95-0004
[] 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 ~"~.~,,~ ~ J ~/ ~_j Date /._ ,~. ~;Z~ Date Certificate
Issued: Due:
Subregistrar Signature
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 de 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 [] STORAGE
[] CREMATION [] OTHER (Specify)
Signature of Sexton )
or Person-in-Charge) ~{;.~,,~'~
CEMETERY OR CREMATORY
Place of Disposition ~:_Z..~-.~.~.
Date of Disposition
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 59 (Re,laces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)