HomeMy WebLinkAbout2-46-02F
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Artistry in
Memorials it
Merritt Monument Company, Inc.
4820 South U. S. Highway 1
Fort Pierce, Florida 33450
Phone: 464 -5547 or 464 -3755
MARCH 249 .981
For Approval
SEBASTIAN CEMETERY
CITY OF SEBASTIAN
SIZE: 28" x 17" x 4"
NAME:
CHARLES G. HOLMES
DEC. 279 1911
NOV. 279 1980
LEGAL DESCRIPTIONt
SECTION:
BLOCK: 46
LOT: 2 unit 2 addition
SPACES
SQUARE FEET:
CHECKED BYt
Granite - Marble
Bronze
TECEIVED MAR 2 7 1981
(2--4 x 1 -5 x 0 -4)
MERRITT MONUMENT CO., INC.
4820 S. FEDERAL HWY.
FT. PIERCE, FLA. 33450
APPROVED: N "`
DATE: /� �oo
'THEY HAVE NOT BEEN FORGOTTEN "
CEMETERY RECORD STATE OF ILLINOIS PERMIT NO.
PERMIT FOR DISPOSITION OF DEAD HUMAN BODY
DECEASED— NAME jy\ FIRST MIDDLE LAST SEX DATE OF DEATH (MONTH, DAY, YEAR)
fit, ji
AGE — LAST PLACE OF DEATH COUNTY ITY, TOWN, TWP. OR RO D DISTRICT NUMBER U. S. WAR VETERAN
BIRTHDAY (YRS.) (, , I (YES/NO)
Deed 423
Charles and Julie Holmes
Box 268 Fleming Grant Rd.
Micco
Charles interred 1213180, lot 2
Deed. '# 42.
Paid by eme 'Meipt No. . , 215. , _ , ...... , Dated... Dec 4.'...19.8 0 .. • • Mrs. Charles G. Holmes
Box 268 Fleming Grant I
List Price $. *A35000*.*. Maximum No. Burial spaces ..... .... Xcco
Discount $ .................. Total area in square fat ................ Block 46, lots ', Unitddl
* *350.00 ** Flat /Ta-
Net Paid $....... ........ Monument permitted .................. Charles interred 12 -3 -1
a f /� (Data above this line for City Record only) -
DISPOSITION AUTHORIZED
CAUSE Of
❑ HOLD BODY BEYOND 72 HOURS
DEATH: k t 1 r '' 6 f ;
Z
['INTERMENT,, ON (DATE) � . ?; / `�. Gf
PLACE, OF DISPOSITION (NAME AND LOCATION OF CEMETERY, CREMATORY OR LABORATORY)
O[3
GREMATiON; ON (DATE)
�-r ) or` A) Ot' tt I. .•ft I'�i - f �l��I '' 'i` C,T j
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PLACE OF DISINTERMENT (NAME AND L TION)
❑ ❑DISINTERMENT
W TRANSIT
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❑ SCIENTIFIC STUDY ❑ REINTERMENT
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THE REQUIREMENTS OF ILLINOIS Llr HAVING BEEN MET, THIS PERMIT TO DISPOSE OF A DEAD HUMAN BODY IS ISSUED TO,
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FUNERAL DIRECTOR;: ILL LICENSE NO. �G )
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ADDRESS '
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(SIGNED) LOCAL JtEGISTRAR
DATE:,r/r �� �Y rj
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REGISTRATION ADDRESSa
BY: .y
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SEXTON'S ENDORSEMENT:
d
THWO ACCOMPANYING THIS P RMIT WAS RECEIVED ANO WAS INTERRED CREMATED
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ON ( ' �` 19 c IN
S '"" CEMETERY OR CREMATORY— NAME
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LOCATED AT _ ' i-A, -mot. •, )1 ". �
(SIGNEQ)' •
..k SEXTON
GRAVE OR VAULT: BLOCK LOT
GRAVE
SEE OTHER SIDE
ILLINOIS' DEPARTMENT OF PUBLIC HEALTH!! SPRINGFIELD
Va zoa( P. o. 15 166- 80" 9/79)
I
Block 46 lots1
and 2 Unit 2 Addition
Deed 423
Charles and Julie Holmes
Box 268 Fleming Grant Rd.
Micco
Charles interred 1213180, lot 2
Deed. '# 42.
Paid by eme 'Meipt No. . , 215. , _ , ...... , Dated... Dec 4.'...19.8 0 .. • • Mrs. Charles G. Holmes
Box 268 Fleming Grant I
List Price $. *A35000*.*. Maximum No. Burial spaces ..... .... Xcco
Discount $ .................. Total area in square fat ................ Block 46, lots ', Unitddl
* *350.00 ** Flat /Ta-
Net Paid $....... ........ Monument permitted .................. Charles interred 12 -3 -1
a f /� (Data above this line for City Record only) -