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HomeMy WebLinkAbout2-45-09\ w \ , / a � /�\ Z b � y . : � y THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: Dollars ($ Oov ) on this day of 1981 for the purchase of the following described Cemetery Lot(s) u n the terms and conditions as stated herein: 'Description of Property: Cemetery Lot (s) # V Block# Unit# Purchase Price: k_ Dollars ($ d v ) Terms and'conditions of sale: 'C6 z;#. � -- 4f aoo. ov 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: M. li •� : �.. j pia, 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 of Aebastian Name_. Unit_ .-h t`r Block "ill _`.;— Lot Date of Mark-out- Date of Burial_ /�'�,.r' %',1'� Time ", %' Name of Funerali'Home 1✓ sue' . Authorized by ° - BOYD, LLOYD P. AND CONSTANCE BLOCK 45, LOTS 9 & 10 730 S.W. KROEGEL UNIT #2, Addn't. SEBASTIAN, FLORIDA 32958 DEED # 465 589 -1777 RECEIPT # 271 LOTS 9 & 10, BLOCK 45, UNIT #2, ADDN'T. Cemetery Paid by G Receipt No. .. 271 8 -3 -81 Dated............................. List Price $......200..00, Discount —0— Net Paid a. , , 200.00 R & R ISSUED WITH DEED #465 Maximum No. Burial spaces ......2 Total area in square feet ...* Monument permitted . Flat (Data above this line for City Record only) DEED # 465 UNIT #2 ADDN'T., BLOCK 45 LOTS 9 & 10 LLOYD P. & CONSTANCE BOYD 730 S.W. KROEGEL AVENUE SEBASTIAN, FLA. 32958 589 -1777 State of Florida, DepartrpAnt of Health and Rehabilitative Services, Vital Statistics �� © APPLICN FOR BURIAL- TRANSIT PERMIT A. (Type or Print) �/ °21�1 1. Name of First Middle Last DATE Month Day Year Deceased OF Lloyd Preston Boyd DEATH 10/22/1996 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or 3. Name of Medical Medical Examiner Address Phone Number Certifier Physician 777 37th Street _ 4. Name of Funeral Hornii Address Fla. Lic. No. /Reg. No. Phone Number (Area Code) Direct Disposer 5. Check a 0 The medical certification has-been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b X❑ Sherri was contacted on +- 9996 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 Mi Chaol W00=M4 ng, M-[- 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 ofSegstian Cemetery In state cemetery/ Removal Final Dispose eon: matory - na / unty: from state Donation 7. Funeral Director/ ignature F.E. No. /Reg. No. Date Signed wee s r 1 a �0 2 B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No.1228 -96 -0490 ❑ 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 "Funerat 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. �ie�istrar.e� Date /a �1z%9 G Date Certificat�vly�.l9 G Subregistrar Signature Issued: 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 required for all cremations. D. CEMETERY OR CREMATORY Methods of Disposition: Place. of Disposition Sebastian Cemetery ® BURIAL ❑ STORAGE Date of Disposition- October 25, 1996 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in- Charge) 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)