HomeMy WebLinkAbout4-27-38THE SEBASTIAN CEMETERY
CITY OF SEBASTIAN, FLORIDA
Az 11'1'
REBY AD
LE D
OF THE SUM OF.
Doll s
$ �,--�
FROM:
w
on this
following
��ayof , 19the
described Cem Lots) upon
purchase of the
conditions
as stated
herein:
the
terms and
Description of Property:
Cemetery Lot(
Purchase P_. e: ,rte
Terms an Condition of sale:
unit
_ Dollars ($��
This contract shall be'binding upon both parties, the seller and the
purchaser, when approved by the owner of the property above described.
I, or we, agree to purchase the above described property on the terms
and conditions stated in the foregoing instrument:
The City of Sebastian agrees toell the
above
gm tion d property to
the above named purchaser (s) on �t I!d / itio�s stated in the
above instrument. I
City 16 eb i
Witness
9
W
D_5m ME'Nf OA�T State of Florida, Department of Health, Vital Statistics
1`1 1 ,Y APPLIC4PN FOR BURIAL — TRANSIT PERMIT • a 7
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
James D. Cooney DEATH 4/25/98
2.
Place of Death
City, Town or Location Name of (If neither, give street address)
County
Hosp. or
Inst.
Indian
166 Sa
3.
Name of Medical
Drive
Medical Examiner A ress Phone Number
Certifier
2147 10th Avenue
Robert A. Schlamowitz, MD Physician Vero Beach.,FL 32960 (561)569-9184
4.
Name of Funeral Home/
Address
Fla. Lic. No./Reg. No.
Phone Number (Area Code)
Direct Disposer
735 Fleming Street
Young & Lowther
Funeral Home
Sebastian,Florida 32958
2350
(561)589-1933
5.
Check a
❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro-
this application.
priate
Box bn
was contacted on 4/2V9@ 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 be 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.
6.
Place of
In state cemetery/ Removal
Final Disposition:
cremat - name/ ounty: from state Donation
7.
Funeral Director/
Direct Disposer
Sign ture F.E. J�Ip.i IeTo.
C._ Gu `'�
ppte Sig�d
C.� 2 7
B. BURIAL—�TR,�►NSIT PERMIT Permit No. 2350-98-016
Permission is hereby granted to dl se of this body. �„f
❑ 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.
5d No extension of time for ' 'ng the death certificateueste .
Registrar or Date L4 Date Certificate
Subregistrar Signature Issued: 1 — ���'�� Due:
C. 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 be obtained before disposal by any of the above methods. A waiting period of 48 hours after
death is require for all cremations.
D. CEMETERY OR CREMATORY
Methods of Disposition: Place of Disposition -,(. 1s 6.
BURIAL ❑ STORAGE Date of Disposition as _(Z a
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in -Charge)
This permit must be endorsed by the Secton or person -in -charge (or by the Funeral Director/Direct Disposer when there is no Sexton)
and returned within 10 days to the local County Health Department in the County where disposition occurred.
DH 326. 10/96 (Replaces HRS Form 326 which may be used)
(Stock Number: 5740-000-0326-2)
Name
Unit
Block , 7
Lot
Date of Mark -out �� � jr/ 510
Date of Burial 9 �S Time
Name of Funeral Home
Authorized by
/! ' 0() i. 67