HomeMy WebLinkAbout2-49-03w 13i4,e.-Aj' 34
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STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITAT SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL - TRANSIT PERMIT
NAME OF
First Middle Last
DATE Month Day
OF
Year
DECEASED
(Type or print)
James Wi
1bur
DEATH 12,
lqgl
PLACE OF DEATr
CITY. TOWN,
OR LOCATION
NAME OF (If not in hospital, give
HOSPITAL OR
street address)
COUNTY
INSTITUTION Sebastian River
Medical
Indian
R
Attending Physician.
yr
(Name of Medical Certifier) (Address)
Medical Examiners
:- Muhammed Siddi ui
M.D. 935 Barefoot Blvd. Sebastian Florida
329SB
Funeral
(Name)
(Address)
Home Flo d /Strunk Funeral Home
2405 14th. Ave. Vero Beach Florida 32960
Check A A completed certificate of death accompanies this application.
One
B 6 c Dr. S i ddiqui was contacted on July 14 ,19 Al
He has assured me that this death was from natural causes and that he will complete and sign the medical
certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medical Examiners jurisdiction.
The body was released to me by
,19
ignature) (Fla. Lic. No.) (Date Signed)
Funeral
Direct 2294 July 14, 1981
BURIAL TRANSIT PERMIT Permit
No. 130 -946
Permission is hereby granted to dispose of this body by burial, transportation out of state, storage or cremation. For cremation a
waiting period of 48 hours after death must be observed and the Medical Examiner's approval must also be obtained.
Signature of
Registrar
[; A five day extension of time for filing the death certificate has been requested and granted.
Date
Issued July 14 , 1981
CEMETERY OR CREMATORY
Method of Disposition Date of
_ BURIAL Disposition July 16, 1981
CREMATION
STORAGE Place of Sebastian Cemetery
i OTHER(Specify) Disposition Sebastian. Tn v r7ian Ai - Cglint» F'7griG
Signature of Sexton
or Person in Charge �p �f �,, _ . _ ,,A
This permit must be endorsed by the sexton or person in charge (or by the funeral director when there is no sexton) and returned
within 10 days to the local county health department.
HRS Form 326 (1/77)
GRAY, EVA P. (MRS.)
P. O. BOX 514
SEBASTIAN, FLORIDA 32958
BLOCK 49 LOTS 3 & 4
DEED # 447
UNIT # 2 ADDITION
Dr. James Wilbur Gray - Interred 7116181 Lot #3
GracU-Cfewdrlz
BLOCK #49 LOTS 3 & 4
MRS. EVA P. GRAy
P. O. BOX 514
SEBASTIAN, FLORIDA 32958
UNIT #2 ADDITION
DEED # 447
Dr. James Wilbur Gray Interred 7116181 - Lot #3
CEMETERY
Paid by dXreiUlleceiPt No. .2.52..:: Ma
Dated ..... y .. 21.• 19 81
...............
List Price
' ' ' • - Maximum No. Burial spaces ..z. .
Discount $..... *.0. *.......... ......
Total area in square feet * *'�
Net Paid 200 00 ** ...... • • •
Monument permitted f4kt
R(Data gbove this I. fox C'ty geco d only)
-- - & tt issue wit Deed
- - - - -- - -
---v-
DEED #447
Gray, Mrs. Eva P.
P. O. Box 514
Sebastian, Florida 32
Unit #2 Addn. , B1k. 4,
Lots � & 2.
DEED #447
THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
* *Two Hundred no /oo * * * * * * * * * * * * * * * * * * * * * * * * * ** *Dollars ($* *200.00 * * * * * *)
FROM: Eva P. Gray
on this 21 day of May , 1981 for the purchase of the following
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot(s)# 3 & 4 Block# 49
Unit# 2 Addition
Purchase Price: Two hundred & no/6o * * * * * * * ** *Dollars($ 200.00 )
- Terms and'conditions of sale:
Paid in full by check
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 to sell the above mentioned property to the above named
purchaser(s) on the terms and conditions stated in the above instrument.
City 6f SaSastian
r
Witness