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� �, HAZEL
9325 10I COURT
VERO LAKES ESTATES
VERO BEACH, FLORIDA 32960
V /
� RECEIPT N018
DEED 1�1043
LOTS 21 & 2�2t, BLOCK 39, UNIT 1 ADDITION
Richard Ours interred 10/26/84
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Paid by CEMETERY Receipt No. . . 018 . . . . . . . . . . Dated . . , 3 /20 /85 . . . . . . , . ,
........ NO.
ISst Price S . �00 : 00 . . . . . . . . . Maximum No. Puciat Spaces . . . . ?.. . .. .. . . . .
Net Paid S,'�� :�� , F1 a t 10 4 3
Monument permitted . . . . . . . . . . . . . . . . . . . . . . t•'
Lots 21 & 22, B1ock 39, Unit 1 Addition �Haze1 Ours
9325 101 Court, Vero Lake Estates
(Data �bo�e thls Une !or Cftr Record only) Vero Beach, Florida 32960
�`� CE M
Index:RECORD #
Last Name
Address 1
Address 2
City
Deed #
Unit #
Lat Numb�r
Lat Mumber
Lot Number
Lot Number
Comment
Comment
City of Sebastian, FL - Cemetery Lots
OURS First Name HA�EL
9325 101 COURT
UERO BEACH State FL
1043 Date 03-20-85 Amount
1-A Block # 39
21 Interred
22 Interred OURS, RICHARD C�et>
22 Interred Haael OursCcremains)
Interred
SOLD LOT #Z1 BACK TO CITY 5/1/90
CF�wrd {B�ack <E>dit CD>elete <N>ext CP
Monday, Dec 27, 2004 09:51 AM
Zip
$?00
Record:6
32960-
Dte Interred
Dte Interred 10-26-84
Dte Interred 03-06-98
Dte Interred
CL>abel CT>acr <Esc>
STATE OF FLORIDA
EPARTMENT OF HEALTH & REHABILI?�/E SERVICES !, �� ,���• �//�
ViTAL STATISTICS
APPLICATION FOR BURIAL—TRANSIT PERNi1T
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased O F
RICHARD BOYD OURS DEATH October 24, 1984
2. P�ace of Death City, Town or Location
County
Indian River Vero Beach
3. Name of Medical �Physician
Certifier Alastair Kenn�edy M. D. � Medical Examiner
Name of
Hosp. or
Inst.
(If neither, give street address)
9325 101st Avenue
Address
1300— 36th St., Vero Beach, Fla.
4. Funeral Home/ Name qddre
Direct Disposer Strunk Funeral Home 734 N. Central Ave. , Sebastian, �'lorida 32958
5. Check a� The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
10/25/84
Boxte b� Eddie was contacted on . He/she.�erified that
this death was from natural causes, that there was no accident nor other external cause of death, and that
Dr. Kennedy will complete and sign the medical certification of
cause of death.
6. Funeral Director/
Direct Disposer
e.
C
�
c� was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medical certification.
Signature
Fla. Lic. No./Reg. No
F.D. �� 2088
BURIAL—TRANSIT PERMIT
Date Signed
October 25, 1984
Permit No1228-84-314
Permission is hereby yranted to dispose of this body.
� A five day extension of time for filiny 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 �j'/% � �� �� ��t° �� October 25, 1984
Sub-Registrar Signature� ✓—!�-� Issued
AUTHORIZATION for CREMATION, DlSSECTION 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 obtainPd before disposal by any of the above methods. A waiting period of 4B hours after death
is required for all cremations.
Method of Disposition:
� BURIAI. ❑ STORAGE
� CREMATION � OTHEii (Specify)
Signature of Sexton ►
or Person-in-Charge ►
CEMETERY OR CREMATORY
PlaceofDisposition Sebastian Cemetery I
Date of Disposition � c t o b e r 2 6, 1 9 8 4
,
Deborah C. Kracres, �'itu CZerk
This permit must be endo�3ed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) I
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.)