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Unit � � ,
Block �" —`
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Lot .
Date of Mark-out ���'� � �� � -
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Date of Burial r�� � �� � Time • , . -
Name of Funeral Home� ��`"� h! �� �
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Authorized by ' ��-
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UNIT 2 addn.
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BLOCK 43 LOTS 9& ZO
HULSE, MORGAN
HULSE, CLARA
9660 Riverview Drive"Micco"
Sebas�ia'n, F1. 32958
J
DEED # 483 2-3-82 ,
k�����% _ �' 3a /90 :
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CEMETERY
Pafd bY litC�4t� Receipt No. . . 2 9.8. . . . . . . . . . Dated . . . . F e �p.�.4 a �; y. . 3.. . .�.� 8 2
HULSE, MORGAN OR CLARA
Maximum No. Bnr1s1 epacea ...2.......9660 .RI.`VERVI'EW` pRIYE "MICCO"
, SEBASTIAN, FLORIDA 32958
Total area in sqnare feefA' . . �'. . ++t . . t�. . .* . .
.. .. ._ _ _
- -... _ .. .
Monument permItted ...F�A.�.........•�UNIT 2• ADDN. � BLK. 43 LOT 9&�
DEED � 483
I.Tst Prtce �.. .4.50.• QO• • • •
Discount $. .*. . .*. . . #. . .�t. . � .
Net Paid $:::450,.�D.....
R& R ISSUED WITH DEED �Data above thta llne for City Record only)
�
A.
1. Name of
Deceased
State of Florida, Department of Health and Rehabilitative Service Vital Statistics
AP�ATION FOR BURIAL — TRANSIT PERII�
s or Printl
First
MORGAN
Middle
Last
HULSE
� ��
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DATE Month iDay Year
OF
DEATH 4�2�/90 �
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
INDIAN RIVER ROSELAND Inst. g�NA HOSPITAL-SEBASTIAN
3. Name of Medical Medical Examiner Address
Certifier 7955 BAY STREET Phone Number
GARY WEISS, M.D. Physician SEBASTIAN, FLORIDA 32958
4. Name of Funeral Home/ 407-SB9-0700
Direct Disposer
STRUNK FUNER
5. Check
Appro-
priate
Box
.OMES
a �
. ■
c ❑
6 Place of SEBASTIAN
Final Disposition: CEMETERY
�• Funeral Director/
�es�9ispaser
B.
C.
�
Address Fla. Lic. No./Reg. No. Phone Number (Area Code)
1623 NORTH CENTRAL AVENUE
SEBASTIAN SEBASTIAN, FLORIDA 32995 4i1228 407-589-1000
The medical certification has been completed and signed. A compieted certificate of death accompanies
this application.
was contacted on 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 will complete
and sign the medical certification of cause of death.
medical certification.
In state cemetery/
crematory - name�
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
SEBASTIAN CEMETERY
Y� SEBASTIAN, FLORIDA
• F.E. No./laeg.�lc,.
� !tt ���
BURIAL — TRANSIT PERMIT
Removal
from state 'n ponation
Date Signed
Permission is hereby granted to dispose of this body. Permit No. 122�-90-226
❑ 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 Iimit. If the certificate cannot be filed within this extended time limit, a"Funeral �irector/Direct
Disposer ReporY' will be filed with the Local Registrar of the County in which death occurred.
❑ No extension of time for fil' g the death certificate r quested.
Registrar or - Date Date Certificate
Subregistrar Signature Issued: 4/27/90 pue:
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
Signature , Medical Examiner Date
or
Medical Examiner, , gave authorization by telephone to
The Medical Examiner's a Funeral Director/Direct Oisposer. Date
pproval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after
death is required for all cremations.
Methods of Disposition:
� BURIAL
❑ CREMATION
Signature of Sexton )
or Person-in-Charge )
❑ STORAGE
❑ OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition SEBASTIAN CEMETERY
Date of Disposition �RIL 30, 1990
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.
IHRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)
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RECEIPT IS HEREBY ACKNOW
FROM:
•
TXE SEBASTIAN CElNETERY
City of Sebastian
Sebastian, Florida
OF THE SUM OF:
?��
Dollars ($_�1�7Q, Q� • j
orI this day o , I9$�for the purchase of the following
described emetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot(s)�i �� �Q B1ock# �s Unit# p? Qd���
Purchase Price: ��rjQ_ �(� D�oZlars($ �Q,;vl�)
�erms and'conditions of sa1e:
-e c�=�,u.c.oe. �.ecf �''�/� a,/�./�a '�-s4�D. D d �
�a,c d.�., �.u.�e,..c�.,�a�6.�.
This contract sha1l be binding upon both parties, the seller and the pr�rchase�r, 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 se11 the above mentioned property to the abov� named
purchaser(s) on the terms and conditions stated in the above instrument.
9
Witness
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