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Paid by CEMETERY Receipt No.... 10 -27 -82
225: 00 .........Dated .... .
............ Maximum N 1 NO.
No- Purial Spaces.... BLOCK 47, LOT 3 5 u
Net Paid S ..... _ ..... .
Monument permitted..., flat UNIT #2 ADDN.
R & R ISSUED Annie MacKillop
1239 E. Barefoot. Blvd.
(Date above this 1239
for City Record o*) Barefoot Bay. Florida
MACKILLOP, ANNIE
1239 E. Barefoot Bay EED ##506
Barefoot Bay, Circle
y Florida Receipt ## 321
LOT ## 3, block 47, Unit ##2 , Addn.
1 0 &a/
THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
D ; — Dollars ($
FROM:
on this day of , 19 2 for t e purchase of he fol3owing
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot (s) # 3 Block #_Unit#
Purchase Pric 11ars($=
Terms and'conditions of sale:
(�/' � iaj--
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.
I (& '�6� """/
City of Sebast'
Witness
/ � /
STATE OF FLORIDA C
PARTMENT OF HEALTH & REHABILITSE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL— TRANSIT PERMIT
A. (Type or Print)
1. Name of
First
Middle
Last DATE Month Day Year
Deceased
OF
Collin Joseph
Mac Killop DEATH Oct. 23, 1982
2. Place of Death
City, Town or Location
Name of (If neither, give street address)
County
Hosp. or
Orange
Orlando
"It. Orlando Regional Medical Center
3. Name of Medical
Physician
Address
CertifierFranklin Norris,
M.D. ❑Medical Examiner
55 W. Columbia St oriqnrin Fla 328pfi
4. Funeral Home/
Name
Address
30dak Pottinger
& Son Funeral Home S. Indian R'var
Drive Sebastian Florida 32958
5. Check a
-
The medical certification has been completed and signed. A completed certificate of death accompanies
Appro-
this application.
priate b
Box
❑
was contacted on . 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.
6. Funeral Director/
B
c ❑ was contacted on . He /she verified that
Medical Examiner, will complete and sign the
medial c�►tifi>�tion.
re
2368 October 24, 1982
Fla. Lic. No. /Reg. No. Date Signed
BURIAL — TRANSIT PERMIT
Permit No. 759-444
Permission is hereby granted to dispose of this body.
❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and
granted. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Report" will be filed
with the Local Registrar of the County in which death occurred.
Registrar or -t Date
Sub - Registrar Signature Issued 41 -2 �C �-% ' �
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
0
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. Awaiting period of 48 hours after death
is required for all cremations.
CEMETERY OR CREMATORY
Method of Disposition:
®)BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton ► ��
or Person -in- Charge 1��' -7`
Place of Disposition Sebastian Cemetery
Date of Disposition October 26, 1982
This permit must be endorsed by the Se on 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.
HRS Form 326, APR. 81
(replaces previous editions which may be used.)