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THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
FROM:
on this // day of /'/'iit , 19kr pror the purchase of the following
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot (s) # S pt /� B1ock# Unit# Z
Purchase Price: Z 5 _'Pa4' /"' Dollars($
Terms and conditions of sale:
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.
��— d �� C/e%1/1J7�
City of Sebastian
Witness
VA"
STATE OF FLORIDA
�WtPARTMENT 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
Rena Ethel Combs DEATH Nov. 29, 1984
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Orange Orlando Inst. Humana Hospital Lucerne
3. Name of Medical ElPhysician Address
Certifier Paul Urban, M.B. ❑ Medical Examiner 2400 Bedford Rd. Orlando, Fla. 32803
4. Funeral Home/ Name Address
D # &XipW xxPottinger & Son Funeral Home 1200 S. Indian River Drive Sebastian Florida 32958
5. Check a 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.
C ❑ was contacted on . He /she verified that
Medical Examiner, will complete and sign the
i dical cer fication.
2368 Nov. 30, 1984
6. Fu oral Director/ rnature Fla. Lic. No. /Reg. No. Date Signed
f�
B. BURIAL— TRANSIT PERMIT 759 -580
Permit No.
Permission is hereby granted to dispose of this body.
fr] 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 Date
Sub - Registrar Signature ��OjW �
-t t.�1 � Issued �S?"� -� 1 T1
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature Medical54Arniner Date
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 death
is required for all cremations.
D. CEMETERY OR CREMATORY
Method of Disposition:
Q BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge )
Deborah C. Krages,
erk
Place of Disposition SPra°St-_i an Cpmetgn
Date of Disposition Dec. 3, 1984
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.)