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Home My WebLink About1-39-30a� � ' , �. '' _ . ,t� d� �� CUp '� '' . _ _ __J - - % � ' ,f � �.,l.o � 3 y . ,�; r � Q _ . . . . 0� ; � �� I�• �J� �. . .. � 1 �� .. . � �j ` �� . . � . f � � `n .. . . . _ i . FI Y .. V " w� � �, . . 1. ��.� �-oN� . . . . .. .._ � _ �'',� . � z�� _ �� I �,�.�-' � : a •° � � , , .M �� . . � �� q , �p ��✓' ,) a� � a� � 5 �' ��.� �� : o o��a � �� .;��',� � c�, ` � �� ('� , �'�� \�� 3'� � �. n ✓' .. _ . . . ._ . .. , - - ----- . , _ . : . . .. , �. ... .. : y� t,. s� - � . � ...:.., �; _� � � . � . ,� _ ��,lj� _ . � : .J . �-� ��' � R�U� � :: ,ti�� .�``�' � ,�� ,� ;� � - - � • �� : 0� a �, z �` s . :. . , � �� 5 5��,. �'` � h v�� ,��' F =�`, , ; . � �'`` ��, � � ` � . �, �e`�+J �ti yb�� , �� '�- : J.�,� a ��T , � �,,� , � � � . ,. ' _ _: .... : . ,.. � , .� � �I ,�,� � ) O �q'�,��, ;� c ,� � : ; . (q` rv . _ . ......: : . , , ; ,, ,t� .p . .a � � �� , - � r . ,>3 ��. ; . • !�� _ � f"� _ � P,,�Q�''� . �� , ��r� ""`"" �� J,� . _ / � � J ,� . Y' �_� � _ ll" - `'P";y� -- - _�� -- - - ;/ � � . _ .. . . - .: ; , `r J j . .«y _ . �.�..._...j�. � � ..,.�:._� .. _._.` .. �,._.i.�_._�__'� rr.' �. ' ., ., .., ' �' . . . . Name L`.��L fC�2U � Yifi% � 1 Unit �` A Block �ot Date of Mark-out �� y�7 Date of Burial ��"�� Time �- �� ' � QState of Florida, Depart of Health and Rehabilitative Services, Vital�istics APPLICA� FOR BURIAL — TRANSIT PERMIT �/j � �' l 'l./ V / l A. (Type or Print) � � /� 1. Name of First Middle Last DATE Month Day Year Deceased Wi 1 ford Dani el Yates p� TH 01 /19/97 2. Place of Death County Palm Beach 3. Name of Medical Certifier Bharat Dave, M.D. City, Town or Location 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes, 5. : 7 Check Appro- priate Box Place of ,eD3St13Y1 Final Disposition: Funeral Director/ B�Bis�user a ❑ West Palm Beach Medical Examiner Name of (If neither, give street address) Hosp. or inst. Veterans Hospi tal Address 7305 N. Military Trail West Palm Beach, F1 33410 Address Fla. Lic. No./Reg. No. Phone Number (Area Code) 1623 North Central Avenue P.A. Sebastian, F1 32958 1228 (407)562-2325 The medical certification has been completed and signed. A completed certificate of death accompanies this application. ( ) Phone Number � b[� Dr. Dave was contacted on 01 /20/97 within 72 hours after death. He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Bharat Dave, M. D. 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 medical certification. In state cemetery/ l// crsmatorv - name/dountv: It1d1 at'1 Rl V@t' Removal n from state n Donation No. Date Signed � �3 � 2 oi i��is� g. BURIAL — TRANSIT PERMIT 122$_9�-0040 Permission is hereby granted to dispose of this body. Permit No. ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this exterided time limit, a"Funeral Director/Direct Disposer ReporY' will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filing the death certificate requested. �r. �� l , /1 , . _ / � Date Date Certific�P, Subregistrar Signature � M �-��ii1OY�� Issued: �� g � 7_ Due: �/�+ `!'�/9 7 �• AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA [�7 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. CEMETERY OR CREMATORY Methods of Disposition: Place of Disposition �-��M �o.r.,�r�,�. QBURIAL ❑ STORAGE Date of Disposition 7 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person-in-Charge ) �� n/.,._.L 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326. Feb 89 {Replaces Oct 87 edition which may be used) (Stock Number: 5740-000-0326-21 CEMETERY DEED # 497 Paid by General �'�'� No. . . .3:�?. . . . . . . . . . . Dated. . 6-1.�-.$2 . . . . . . . . . . . . . . . . . . KIRKPATRI'CK, ALICE List Price �. . , 450. 00. . , , , Masimum No. Burial spaces . .?. . . . . . • • - j 051 S. W. EMERSON DRIVE Discount $......-.Q-........ Total area in square feet .*...*..*..*..*....* PALM BAY, FLORIDA 32901 Net Paid �, . 450. 00 Monument permitted . ,FI`.�t . . . . . .. . . . . .. UNIT laddn., LOTS 29&30, BLK.39 & R ISSUED WITH DEED (Data above this line for Citq Record oaly) HUSBANL7 INTERRED lot 29 5/Z2/82 e e G . «- • • 3�� THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida � R£CEIPT IS HEREBY ACKNOWLEDGED OF 3'HE SUM OF:, iiL�/i�C.�.,�. _.�mllars !$ e?eZ� O-Z� ) FRO!►!: 1 J' G_/ .l� 1 i �[_ ��5 ..,.�/�� it.S .L-!_ -.�1. /� � i�. _.� ./� ��'� r�� on this /�`� day of , I98? for the purchase of the following described Cemetery Lo�( upon the terms and conditions as stated herein: Description of Property: Cemetery Lot (s) # � B1ock# ��Unit# ��.�ii�- - Purchase Price - ��,.t��c.�o� 11ars f$.�Z�� . o7J ) � Terms and'conditions of sa1e: . �c� e�. Ci.�-o �') This contract sha11 be binding upon both parties, the seller and the purchaser, when apprvved by the owner of the property above described. I, or we, agree to purchase the above described property oa the terms and conditions stated in the foregoing instr►lment: The City of Sebastian agrees to se12 the sbove mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. �� .�c--�—�,n City of Sebastian .�!��, Witness V� �� .• , �� ' ��. , o� �� " �� ,--�' �.� �f � RECEIPT )M: � � TXE SEBASTIAN CEMETERY City of Sebastian Sebastisn, Florida �,. �� rs � � �� /�a--� ,�i / �a��-� � /- , on this �� day of ��.�� , 198� for the purchase of the following described Cemetery Lot(s) upo�i the terms and conditions as stated herein: Description of Property: � Cemetery Lot (s) # a9� B1ock# 0�9 Unit# /��x- . � Purchase Price �l�u.h �,t�u �z�C ��ollars ($� . G�7� ) � Terms and�conditions af sale: . '�� _ � ��iis contract shall be binding upon both parties, the seZler 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: t . , �4 The City of Sebastian agrees to seZl the above mentioned property to the ahove named ,. �" purchaser(s) on the terms and conditions stated in the above instrument. . /C�t:c-,� City of Sebastian �� i � Witness