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HAAG, �Zma and/or Haaq,�Larry and/or Cavender, Judy
Deed #540
Lots 2& 3, BZock 37, Unit Z dditional
�ti�-Q � ,,�-C-�`. �/�7 C� �G�'V" c�
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DEED #/540 Receipt #36C
Paid by CEMETERY Receipt No. .36D. . . . .. . . . . . . Dated . . , .Z.Q,-�6, ,-�4 , , , , . . . .
300. 00 ........ NO. � � r�;
List Price $ . . . . . . . . . . . . . . Maximum No. Purial - 2 -
. Spaces............
���" AZma Haa
NetPaid$ „300:00 .f1at 9' and/or Larry Haaq
•••••••••• Monumentpermitted.,,,,,,, or Jud
• • • • • • . ...... . / y Cavender
R& R Issued 13225, U,S. #1, Lot#54
Sebastian, FIa, 32958
(Dab sbove t.�b line !or C[ty Record only) LOTS �& 3, B 1 k. # 3 7, # 1 Ad dn t.
Name_ �ft71�� 7�-1I�If� b�r
un�t / �d�
Block � /
Lot �
Date of Mark-out
7 ��i�
Date of Burial ��'t.�/ �(�' Time rs�.�OGi �3
�
Name offuner;21 Hom
1
Authorized by
=�`�'�N-�( �S
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� State of Florida, Departme f Health and Rehabilitative Services, Vital St tics � �
APPUCATI�OR BURIAL — TRANSIT PERMIT � �
A. (Type or Print) `� I "
1. Name of First Middle Last DATE Month Day Year
Deceased �lma H�� DEATH 08/25/96
2. Place of Death
County
3. Name of Medical
Certifier
City, Town or Location
Ve
Medical
Name of (If neither, give street address)
Hosp. or
Inst. - - • - • - - . .
Address
777 37th Street
Phone Number
Muhammad Faroo . M.D. X Physician Vero Beach Florida 32960 56 7- 77
4. Name of Funeral Home/ Address Fia. Lic. No./Reg. No. Phone Number (Area Code)
Direct Disposer
1623 North Central Avenue
Strunk Funeral Homes, P.A. Sebastian. Fl 32958 122 4'7 -
5. Check a❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box b� �,,,�„� - was contacted on 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 ��hamm rl Farcx�q. M. �_ will complete
and sign the medical certification of cause of death.
C�
7
B.
c ❑
medical certification.
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
Place of Sebast ian CemeteTy � t te cemetery/ Removal
Final Disposition: re at - name/ Indian RiveT from state Donation
Funeral Director/ S' e � F.E. No./Reg. No. Date Signed
Direct Disposer � � $1 Z
BURIAL — TRANSIT PERMIT 1228-96-0401
Permit No.
Permission is hereby granted to dispose of this body.
❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a"Funeral Director/Direct
Disposer ReporY' will be filed with the Local Registrar of the County in which �ieath occurred.
❑ No extension of time for filing the death certificate requested.
�r Date Date Certificate
Subregistrar Signature � �-'� • � Issued: � �/ Due:
C.
�
Signature
or
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
, Medical Examiner Date
Medical Examiner, , gave authorization by telephone to
Funeral Director/Direct Disposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after
death is required for all cremations.
CEDlIETERY OR CREMATORY
Methods of Disposition: Place of Disposition
� BURIAL ❑ STORAGE Date of Disposition � G
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person-in-Charge ) � �� - 1- ��
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton)
and returned within 10 days to the local HRS County Public Health Unit in the County where disposition occurred.
HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)
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RECEIPT IS XEREBY
FROM:
•
TKE SEBASTIAN CSI�IETERY
City of Sebastian
Sebastian, Florida
OF TNE SUM OF:
�6�
D�ollars (� OD
/ 'I
w
�,-, / >/. � �/
�
on this�day of�1���j� 19B,� for the purchase of the following
described Ceu�etery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot(s)q� 1L�,� Block# � Unit�i f_�/ ��/ ,
Purc��� Pr� : ,L�, � D � � D�o.2lars ($����
.-v -
�erms and'cond'tions of sale:
L�'�:�� C��GC C..•c-- �lp �' .1/J�., l'�-�- C!%:�
q� 4 �
� ��O '
This contract sha11 be binding upon both parties, the seller and the pvrchaser, 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:
���s�%-
I
The City of Sebast.ian agrees to sell the above mentioned property to the above named
pterchaser(s) on the te�ms and conditions stated in the above instrument.
• � � i L �-��. , - —
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Witness