HomeMy WebLinkAbout1-38-06Paid by CEMETERY Receipt No 359
Dated 10/17/83
4 50.00 rs
List Price NO.
Maximum No. Purial Spaces 2 Mildred Bryant, and/or Sandra Ei
Net Paid$ 450.00 13450 99th St.
Monument permitted F1 a t Fellsmere, Fla.
32948
Lots 5 6, Block 38, Unit #1 Additional
(Data above this line for City Record only)
Lots 5 6, Block 38, Unit #1 Additional
Deed 539
Mildred Bryant, and /or Sandra Ellis
13450 99th Street
Fellsmere, Florida 32948
Thomas Bryant
Interred 10/18/83, Lot 6
A. (Type or Print)
1. Name of
Deceased
2. Place of Death
County
Brevard
6. Funeral Director/
Direct Disposer
D.
Xf52
Registrar or
Sub Registrar Signatur
Signature of.Sexterr
or Person -in- Charge
First
THOMAS
c
City, Town or Location
Melbourne
medical certification.
B. BURIAL TRANSIT PERMIT
HRS Form 326, APR. 81
STATE OF FLORIDA
_PARTMENT OF HEALTH REHABILITA
VITAL STATISTICS
SERVICES
APPLICATION FOR BURIAL TRANSIT PERMIT
.4
Middle Last DATE Month Day Yez
OF
HARDWICK BRYANT DEATH Oct. 16, 1983
Name of (If neither, give street address)
Hosp. or
Inst. Holmes Regional Medical Center
3. Name of Medical `j Physician Address
Certifier RrJrry MiZZA M.D. ❑Medical Examiner 200 E. Sheridan. Avenue., Melbourne,
4. Funeral Home/ Name Address
Direct Disposer Strunk Ftinoraj 1-10m0. 734 North Central. Avenue., Aabastian, Florid
5. Check a The medical certification has been completed and signed. A completed certificate of death accompai
Appro- this application.
priate
Box
b Pat (sec'?4) was co 0/17 He /she verified t
Wit deathwas from natural reuses, that there was no accident nor other external cause of death, and 1
Dr. Mills will complete and sign the medical certificatioi
cause of death.
9 Zignature Fla. Lic. No. /Reg. No.
2 B�^- 1672
was contacted on. He /she verified'
Medical Examiner, will complete and sign
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
granted. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Report" will be
with the Local Registrar of the County in which death occurred.
Date
Issued
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL AT SEA
Signature Medical Examiner De
or
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 d
is required for all cremations.
CEMETERY OR CREMATORY
Place of Disposition. C'
Date of Disposition
Date Signed
October 17, 1983
Permit N0/228
October 17, 1983
Method of Disposition:
IA LI3URIAL STORAGE
CREMATION OTHER ecify)
4.1 A4-eleg-tt7 Q4.-Leji-Ok
lfi
Deborah C. Krages, City Clerk, City of Seb stian
This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Se;
and returned within 10 days to the local County Health Department in the County where disposition occurred.
RECEIPT IS HEREBY AC
FROM:
Witness
THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
OW DGED OF THE SUM OF:
zet
/3, 9
Terms and' cFlfiditions of Bale:
r., (J
on this d y of (J 9$d for the purchase of the following
e
35
described Cemetery Lots upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot (s) vti7 �p Block# Unit#
Purchase Price: Dellars($ o�
Cep 'lid n°
lv 3 5423
v
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:
m em,/ enInt--41
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.
y of e stian