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� THE SEBASTIAN CEMETERY � V�4 C ity of Sebastian -,
Sebastian, Florida's
v
RE IS EREBY eACKNOWLEDGED OF THE SUM OF:
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FRO
17
t o� day of . 7.G�.rr 1982 for the purchase of the following
c d Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
t
Cemetery Lot (s) # // Block# Unit#
Purchase Price Dollars ($
Terms and'conditions of sale:
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 of Sebasti
Witness
STATE OF FLORIDA A % Z/a�
DEPARTMENT OF HEALTH & REHABILITiE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL— TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
Maria Tschugunova Erlemann DEATH Feb. 22, 1982
2. Place of Death City, Town or Location
County
Name of (If neither, give street address)
Hosp. or
Indian River County, Sebastian,Florida Inst. Sebastian River Medical Center
3. Name of Medical 91 Physician Address
Certifier Dr. Lanfield, M.D. []Medical Examiner 115 N.W. Palm Bay Road, Palm Bay, Fla 32905
4. Funeral Home/ Name Address
Direct Disposer Brownlie & Maxwell Funeral Home, 1010 E. Palmetto Ave.,Melbourne,Fla 32901
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate b ® Dr. Lanfield was contacted on 2/22/82 . He /she verified that
Box this death was from natural causes, that there was no accident nor other external cause of death, and that
He will complete and sign the medical certification of
cause of death.
6. Funeral Director/
Direct Disposer
B.
was contacted on . He /she verified that
Medical Examiner, will complete and sign the
medical certification.
Signature
596
February 25, 1982
Fla. Lic. No. /Reg. No. Date Signed
BURIAL — TRANSIT PERMIT
Permit No. 492C77C
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 Fegistrar ofxhe CounWin which death occurred.
Registrar or
Sub- Registrar Signatu
Date February 25, 1982
Issued
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
A
Signature
or
Medical Examiner,
Medical Examiner Date
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.
Method of Disposition:
BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton ►
or Person -in- Charge 1 C�
CEMETERY OR CREMATORY Sebastian Cemetery
Place of Disposition Sebastian, Florida
Date of Disposition
uc.x
This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when thelre 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.)