HomeMy WebLinkAbout2-06-08Paid by CEMETERY Receipt No ... 368 .......... Dated ... 3,/8 /84 ...................
-NO.
U U5 4 9
List Price $ „150: 00 ... , , ...
Maximum No. Purial Spaces... --A :..........
Dorothy W. McKinley
15 0 0 0
Flat
494 S . W . Easy St.
.
Net Paid $ ........00 ........
Monument permitted . , , , ..................
Sebastian, Florida
3295
Lot 8, Block
6, Unit 2
7 V4 3.0 \v \
3
rE
BLOCK LOT r/, UNIT 2 DEED 6549
Dorothy W. McKinley
494 S.W. Easy St.
Sebastian, Florida 32958
Joseph interred 3110184
STATE OF FLORIDA
ARTMENT OF HEALTH & REHABILITA�%IIIIII SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL — TRANSIT PERMIT
A. (Type or Print)
A8 66' Z/ a
1. Name of
First
Middle Last DATE Month Day Year
Deceased
OF
_
JOSEPH E. McKINLEY DEATI March 7 1984
2. Place of Death
City, Town or Location Name of (If neither, give street address)
County
Hosp. or
Indian River
Vero Beach Inst. Indian River Memorial Hospital
3. Name of Medical
)[N Physician Address
Certifier Michael
Zimmer
M.D. —_ E] Medical Examiner 2300 5th Avenue. Vero Beach Florida
4. Funeral Home/
Name 734-N. Central AvenueAgdregebastIan, Florida
Direct Disposer
Strunk
Funeral Home., gifixiglkxS :txeaXx*xuaxexHaaxkxxR;Jmxida
5. Check
a
The medical certification has been completed and signed. A completed certificate of death accompanies
Appro-
this application.
priate
Box
b
Gay (nurse) was contacted on _318184. He /she verified that
this death was from nalural causes, that there was no accident nor other external cause of death, and that
Dr. Zimmer
complete and s1911 the medical certification of
cause of death.
c was contacted on . He /she verified that
Medical Examiner, will complete and sign the
medical certification.
6. Funeral Director/ Si tature Fla. Lic. No. Reg. No. Date Signed
Direct Disposer
March 8 1984
B. BURIAL— TRANSIT PERMIT 130 -84 -102
Permit No.
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 wit in this time limit, a "Funeral Director /Direct Disposer Report" will be filed
with the Local Registrar of the C unty in which death occurred.
Registrar or
Sub - Registrar Signatu
Issued March 8, 1984
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
C
Signature
or
Medical Examiner,
, Medical Examiner Date
, 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.
Method of Disposition:
X BURIAL STORAGE
CREMATION OTHER (Specify)
Signature of Sexton
or Person -in- Charge
CEMETERY OR CREMATORY
Place of Disposition Sebastian Municipal Cemetery
Date of Disposition 3 -10 -84
Deborah C. Kra
City Clerk
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.)
S
THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
Dollars ($ /.:S0 -00 )
FROM:
C
� Q 6— ��
�c:����; ►d�J �� -OQ��d 3JgS�
on this 'R }'" day of fi)dV o 1A 1984 for the purchase of the following
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot (s)# Block #( Unit# a..
Purchase Price .()%-')(-- ALMA , LLI V'S �L4 Dollars($ 1S O 00 )
T
Terms and' condi tions of sale:. -• C \� �� (,
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.
City of S ba t an
Witness