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Paid by CEMETERY Receipt No.. 3 7 2.... _ ... _ . Dated ...4123184
..4 / 2 3 / 8 4 ... . ........... .
List Price $ ...... 350 . 0 0 .. Maximum No. Euiial Spaces ....1........... .
Net Paid $ ....... 50 . 00 .. Monument permitted ......... Z a.t........ .
Lot #25. Block 41, Unit 1
(Data above this line for City Record only)
NO.
1607
Rose Marie Muntz
8627 Napier Road
Northville, Michigan 48167
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MUNTZ, ROSE MARIE
8627 Napier Road
Northville, Michigan 48167
Deed #1007
Lot 25, Block 41, Unit 1
Richard Charles Muntz interred 4124184
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MUNTZ, ROSE MARIE
8627 Napier Road
Northville, Michigan 48167
Deed #1007
Lot 25, Block 41, Unit 1
Richard Charles Muntz interred 4124184
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MUNTZ, ROSE MARIE
8627 Napier Road
Northville, Michigan 48167
Deed #1007
Lot 25, Block 41, Unit 1
Richard Charles Muntz interred 4124184
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THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
FROM:
mil/ � 7 /1/i9/� /.C/� //'"/✓
ey 7
on this 37 day of 19k'9'for the purchase of the following
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
1
Cemetery Lot(s)# Z S Block # Unit#
Purchase Price i'� _Dollars ($
Terms and' conditions of sale: pcj ' y --)J "
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 Sebastian
Witness
STATE OF FLORIDA
BI
OPARTMENT OF HEALTH & REHALITOE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL — TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased
Richard Charles Muntz DEATH April 19, 1984
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Br yard Melbourne �st.IffA -- Holmes Regional Medical Center
3. Name of Medical ❑ Physician Address
Certifier L.E. MC HENRY, M.D. ® Medical Examiner 1301 S. Hickory St. Melbourne, Fla.
4. Funeral Home/ Name Addr s
)DCi+6�MX#WCXXXX Pot tinger & Son Funeral Home 1200 S. Indian River Vr. Sebastian Fla.
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 El was contacted on . He /she verified that
(� Medical Examiner, will complete and sign the
y�c YI / di al ertificati
G J� 42368 April 20, 1984
6.
Fine Director/ igna r Fla. Lic. No. /Reg. No. Date Signed
B. BURIAL — TRANSIT PERMIT 759 -544
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 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 Issued L
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature Medical Examiner 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.
19
CEMETERY OR CREMATORY
Method of Disposition:
A�JBLIRIAL ❑ STORAGE
E] CREMATION E] OTHER (Specify)
Signature of Sexton ►
,J
or Person -in- Charge ►�,
This permit must be endorsed by the Sexton or persoi
and returned within 10 days to the local County Health
HRS Form 326, APR. 81
(replaces previous editions which may be used.)
Place of Disposition
Sebastian Cemetery
Date of Disposition April 24, 1984
or by the Funeral Director /Direct Disposer when there is no Sexton)
t in the County where disposition occurred.