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Name �:' �'D� �`� .� P� i i:' ,� �' i� �>•
Unit � �"` f �.�
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Date of Mark-out r' �-
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Date of Burial � � ,.� �' f � � � '
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Time °`' ? �� ,�'�' °
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Name of Funeral Home _ _ __ ��::� ;..-c.: ,�� ,�.... .
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Au#horized by "% � �( . �'� ; .- _
Paid by CE111E1'ERY Receipt No. ... 324, , 12-3-82 '
. . . . . . . Dated . . . . . . . •. . . . . . .
I.ist Price S . 4 5 0 0 0 0 . . . . . . . . . . . . . . . . NO. (� � � �
' ' ' ' ' ' Maximum No. Eurial gpaces , , . . . . - :1 _ �NA STEINACHER �1 �
450:00 ' "6 P Palmers Court
Net Paid $ . . , , , , , , , , , . Monument fZ a t, . . . . . , . . _ .SEBASTIAN, FLORIDA 32958
permitted . . . . . . . .
DEED # 510; RECEIPT /i324
R& R ISSUED LOTS 9& 10 BLOCK 37 , UNIT #1 Addn
(Date� above t3�is line }ur City R�wrd only,� WILLIAM INTERRED IN LOT 9. .32-3-82
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TXE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, FZorida
,• RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
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Dollars ($ ���. �'"� )
FROM: _ � /'�S . � N 11 � ���21 1'� ��Q. r
_ � P �u � vn« S Co �.r-�
��b �.s-� � �..w. , �i . � a-�� �
on this_�_day of ,t..t,l�t�i1�.198= for the purchase of the following
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot (s) # g '✓ /D 81ack# � % Uni t� � �� .
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Purchase Price: �'i�t,,r.�h.,.i(i1.c,i( � 11ars ($ JO. �)
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Terms and'conditions of sale:
p�C�C� ,l�' - � � � ��/�, '���D. Ov
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This contract sha11 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 se1l the above mentioned property to �he above named
purchaser(s) on the terms and conaitions stated in the above instriunent.
li'�-/•
City of Sebast'
Witness
_ __ __ .
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VS 61 (Rev. 7/79) • New York State Departme� Health
� BURIAL — TRANSIT PERMIT
Name: First
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C.1 l/`r
/ N ti A Middle Last • �x
Date of Death � � ��E/ �� C �E2 �
� �� _ s �.7 Age � c If Veteran oi U.�� ed Forces, War or Oates
a
,'� Place of Death: City, Town or Village Hospital, Instituti n or treet A
W �%°� ��43 y�c�N
A Causes of Death. � �y �� R'�
WC��}�Gvr�r►+�+�» Sis �S�O�+�P--- +- f�'�CTU�
A Medical Certifier: Name �1 Title e,
�� c�ERT ` N-E�en�A/< n't � �• .�S�S �dr/S�S �
Death Certificate Filed: City, Town or Village District No.
� s /o�v �"/ 5v
k+. Burial: Date ��ery or Crematory
� Cremation: �(i'- �'j—�'7 �Q.�LS?I-9N CP/►��,e�,
Removal Date Place Removed and or Held
� � and/or Hold:
f�
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N Date Point of Shi nt
O Transportation by �
� � Common Carrier.
A D8te Cemetery Address
� Disinterment:
� Reinterment:
Ti� e ?—
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Register No.
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P��}St�i�•t.
�<o � i�,�-
�� �� ��� ���� �u.�.a���c u� runerai rnm Addr s Registr�� � No.
.4.� G �n� Fu��rL /-/wrc ruc � /7a i ��e,- �.�-C �wf' .�. ,P -� j� l�
Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other Than Above:
� Address: �RV Nk �uN� �� 7�� �0 ` l ��7'RH'L /"Tt�f' • I �— �J�I
� ��T RN/ �
p� Permission is hereby granted to dispose of the dead human remains described above �s i ed
p,� Date Issued � � " � � �' T
„Jr—�,-Z) Regi 810} It21 18�iSli ( ignature) ,
�istrict No.
Place
his permit must be completed on back by the person in charge at the place ot disposition and filed with the registrar of vital statistics of the city, town or villa
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