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Home My WebLink About2-46-14O w --------------------- . . ... ...... ........ --------------------- . . ... ...... ........ CEMETERY Paid by !S&YM Receipt No. . 251 ....... ...... Dated .... 5-21-81 List Price .. *I00.00 * * ** Maximum No. Burial spaces ..I .......... Discount $.... - Q-......... Total area in s * * * * * * * * ** quare feet Net Paid $* *100.00 ** Monument Permitted ..FZat ............ . (Data above this line for City Record only) DEED #446 Prena,, Jerri 317 Fordham Street Sebastian, Florida 32958 Unit #2 Addn., Blk. #46, Lot 1, R. & R. Issued with Deed BLOCK 46 LOT 14 UNIT # 2 ADDITION (MRS.) JERRI PRENA 317 FORDHAM STREET DEED# 446 SEBASTIAN, FLORIDA 32958 Mrs. Maddle Sheets interred 3125185 -Lot 14 �Iw 1-4 DEED #446 THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: One hundred & no/ do * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *Dollars ($ *100.00 ** ) FROM: Jo- r r i Prpn.9 317 Fordham Street Sebastian, Florida 32958 on this 21 day of May , 1.981 for the purchase of the following described Cemetery Lot(s) upon the terms and conditions as stated herein: Description of Property: . Cemetery Lot(s)# 14 Block# 46 Unit# 2 Addition Purchase Price: One hundred & no/oo * * * * * * * * ** *Dollars($* *100.00 * *). 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. 0�,- 1 City of eebastian }'�-- Witness STATE OF FLORIDA PARTMENT OF HEALTH & REHABILITE SERVICES �- VITAL STATISTICS APPLICATION FOR BURIAL— TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF March 23, 1985 Mattie Ann Sheets DEATH 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 317 Fordham 3. Name of Medical Physician Address Certifier Wm. Richardson, D.O. ❑ Medical Examiner 7945 Bay St. Roseland Florida 32957 4. Funeral Home/ Name Address xt=am&tWvmPottinger & Son Funeral Home 1200 S. Indian River Dr. Sebastian , Florida 5. Check a ®x The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b ❑ was contacted on . He /she verified that Box 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/ WX000mmm B. c ❑ was contacted on . He /she verified that Medical Examiner, will complete and sign the me certif' atio # 2368 March 25, 1985 Fla. Lic. No. /Reg. No. Date Signed BURIAL — TRANSIT PERMIT Permit No. Zff0.3e 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 Sub - Registrar Signatu Date Issued�� C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature or , Medical Examiner Date 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 Method of Disposition: [3)BURIAL ❑ STORAGE ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton or Person -in- Charge Deborah C. Kra CittT C1er Place of DispositionSebastian Cemetery Date of Disposition March 25, 1985 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 County Health Department in the County where disposition occurred. HRS Form 326, APR. 81 (replaces previous editions which may be used.)