HomeMy WebLinkAbout2-41-05I`�i.,�..,_ ,,,, R �,
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FORD, Harold and Eleanor
826 Cain Street DEED #373
Sebastian, F1 32958
LOTS 5 & 6 BLOCK 41 UNIT #2
Harold interred 9112183 - Lot 5
9k
Paid by General Receipt No. .. 159.......... Dated.. 10 -4 -79
List Price $. , ?00.00 Maximum No. Burial spaces .. 2 ....... .
Discount $ .................. Total area in square feet ......
Net Paid $ 200.00
Monument permitted .
R &R attached (Data above this line for City Record only)
Paid by General Receipt No. Ck.
List Price $, , , 100.00
Discount $,,,
Net Paid $, , 100.00 ,
a tl
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DEED 373
Harold & El eajaor Ford
826 Cain Street
Sebastian, F1 32958
LOTS 5 & 6 BLK 41 UNIT
Deed #117
Mrs. U'. C. Johnson
Schumann Drive
octal spaces ....,2 Sebastian, Florida 32958
AL
square fat ....
tted
Mine for City only)
UNIT1/.
Blk. 41, Lots 5 and 6
L%J CE
Index:RECORD #
Last Name
Address i
Address 2
City
Deed #
Unit #
Lot Number
Lot Number
Lot Number
Lot Number
Comment
Comment
City of Sebastian, FL - Cemetery Lots
Ford First Name Harold & Eleanor
826 Cain Street
Sebastian
373 Date
2- Block #
5 Interred
6 Interred
Interred
Interred
State Fl
10 -04 -79 Amount
41
Harold Ford (vet)
Eleanor Ford
Zip
$200
32958-
Dte Interred 09• -12 -83
Dte Interred 1202 -78
Dte Interred
Dte Interred
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Tuesday, Mar 08, 2005 09:34 AM
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STATE OF FLORIDA
DoTMENT OF HE LT S RE A ILITATIV•RVICES
APPLICATION FOR BURIAL — TRANSIT PERMIT
A. (Type or Print) DATE Month Day Year
1. Name of First
Middle Last O F
Deceased Harold Barrett Ford DEATH Sept. 9, 1983
e . *roar address)
2. Place of Death
County
Indian River
3. Name of Medical
Certifier Fart
4. Funeral Home/
5. Check
Appro-
priate
Box
6. Funeral Director/
Dxx
F]
a
b ❑
C ❑
City, Town or Location Name or
Hosp. or
Sebastian Inst.
Name
%n 1469.,,-1, W... _-
201 S
Physician
Medical Examiner U.S. # 1 F
Address
The medical certification has been
Address
River Dr. Sebastian r .a. '32958
signed. A completed certificate of death accompanies
this application.
was contacted on 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 ceirtification of
cause of death. was contacted on He /she' verified that
Medical Examiner, will complete and sign the
ma9�a�rtr do /J X112368 Sept. 10, 1983
AL ._
Fla. Lic. No. /Reg. No.
BURIAL— TRANSIT PERMIT
Permit No.
la.
Permission is hereby granted to dispose of this body.
❑ A five day extension of timde for filing the death ites %fFuneralxD rector /Direct Disposer R po�itrequested will he filed
within this time granted. If it cannot be file
with the Local Registrar of the County in which death occurred.
Date
Registrar or Issued
Sub- Registrar Signatur
CREMATION, DISSECTION or BURIAL —AT —SEA
C. AUTHORIZATION for
Medical Examiner Date
Signature
or gave authorization by telephone to
Medical Examiner,
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.
A
Method of Disposition:
xQ BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton 1
or Person -in- Charge )
CEMETERY OR CREMATORY
nronvan c_KRAGES, CITY CLERK
S
Place of Disposition Sebastian Cemetery
Date of Disposition t 12 1983
This returned within 10 days o the local CountyrHeal h Departmentinthe County Funeral
wherre disposition occurred.
Y999,9199
and ret
HRS Form 326, APR. 81
(replaces previous editions which may be used.)
is no Sexton)