HomeMy WebLinkAbout2-01-04Paid by General Receipt No. ... �? NOV 17 , 1976
Dated ..................
List Price $ * *,20;Q,.QO. * *.. .
Maximum No. Burial spaces .....2.....
Discount $........ Total area In
...... square feet ...
Net Paid Monument
Permitted ........... f2o t, .
R &R attached (Data above this line for City Record only)
DEED #302
Mrs. Hugh (Eleanor) Gu
=North '
Central Ave; �'', '�%�� =u- -�
R08ge=3'; -Box 1083-
Sebastian (Roseland)
(North of Cemetery, south
of Roseland Road)
LOTS 4 & 5, BLOCK 1 UNIT #2
GUY, Mrs. Hugh (Eleanor) Deed # 302
Rt. 1, Box 108
No. Central Ave.
Sebastian
(in Roseland, North of Cemetery and South of Roseland Rd.)
Block 1, lots Wand 5, Unit 2.
Hugh Guy interred, lot, 11118176.
EL%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
Guy First Name Hugh & Eleanor
Route 1 Box 108
Sebastian
302 Date
2- Block #
4 Interred
5 Interred
Interred
Interred
Tuesday, Jan 11, 2005 02:35 PM
State
11 -17 -76
1
Hugh Guy
F1 Zip
Amount $200
Dte
Dte
Dte
Dte
it <D >elete CN >ext <P >rev <R >e- search
Record:
32958 -
Interred -19 -76
Interred
Interred
Interred
r �
�J
SIATE (J ii.OkIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL -TRAO PERMIT
`i 5-
NAME OF i First Middle Last DATE Month Day Year
DECEASED OF
(Type or print) Huszh Guy DEATH Nov. 13- 1976
PLACE OF DEATH CITY, TOWN, OR LOCATION NAME OF (If not In hospital, give street address)
COUNTY HOSPITAL OR
Palm Beach Boynton, Beach I INSTITUTION Bethe dg�1 tal
Attending Physician M (Name of Medical Certifier) (Address) 33434
Medical Examinant ❑ Richard C Vollrath 611 S.W. 28th Ave Boynton Reach, via
Funeral (Name) (Address)
Home COLONIAL FUNERAL, HOME S. Indian River Drive Sebastian
Check A [J A completed certificate of death accompanies this application.
One
B ❑ Dr. was contacted on , 19 .
He has assured me that this death was from natural causes and that he will complete and sign
the medical certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medico) Examiners
jurisdiction. The body was released to me by _
on , 19 .
7.9o-t".r e) (Fla. Lic. No.) (Date Signed)
Funeral n Director / ..f, 4 1
BURIACrTRANSIT PERMIT Permit
No. x,59 -6
Permission is hereby granted to dispose of this body by_. burial, transportation_ out of state, - storage or cremation. For
cremation a waiting period of 48 hours after death must be observed and the Medical Examiner's approval must
also be obtained.
❑ A five day extension of time for filing the death certificate has been requested and granted.
Signature of Date
Registrar Issued November 14, 1976
CEMETERY OR CREMATORY
Method of Disposition Date of November 15 1976
® BURIAL Disposition _,
❑ CREMATION
❑ STORAGE Place of
❑ OTHER (Specify) Disposition Sebastian Cemetery
Signature of Se*"
ar Person in Charge
This permit must be endorsed by the sexton or person in charge )or by the funeral director when there is no sexton)
and returned within 10 days to the local county health department.