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BLOCK #37 LOT �18 UNIT #1 ADDNT.
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DEED #537
Receipt �OZ2
ELMER GOLIEN
585 PETERSON STREET
SEBASTIAN, FLORIDA 32958
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... _
Paid by CEMETERY Receipt No. . . . . . . . . Q 1 � . , , . Dated . . . . ,10 � 4 � 83 N�
............... U53'l
� pri� 150 00 EZmer Golien
S . . • . . . . : . • . . • . . . . . Maximum No. Etuisi S oes . . . . . . . . . :1- 5 8 5 Pe te rson S t .
Pa ......
NetPaids 150.00 flat Sebastian, FZa. 32958
. . . . . . . . . • . • . . . . • . Monument permitted . . .
....................
R& R ISSUED (Data ;bove tbb Une tor City Reeord only) Lo t#18 , B1 ock ii3 7, Un i t 1 Ad dr,
__. �' �uf� ��i�--
Name �� � J ,.,t t,.� ,�`_, {>� � � .
"`^'' � �°.,. , n r`�' �r
.„.,,,�
U�llt $� ,t:� $�� ��—� t'—� 4�,�R
`': .'+�
BIOCk `� � �
Lot
Date of Mark-out .� �.if , .:' ,tf;;;:��'
Date of Burial � ;�'-���r '~,�
—�^�-y�--t Time�..��' ''. �'�, � &
—��� .
Name of Funeral Home �°'° `"��
t .' o` r
Authorized by � ���4 �( ��.='�
A. (Type or Print)
1. Name ot First
Deceased ELMER
STATE OF FLORIDA
D�iTMENT OF HEALTH & REHABILITATI�RVICES
ViTAL S7ATISTICS
APPLICATION FOR BURIAL—TRANSIT PERNi1T
Middle Last
CLARENCE GOLIEN
� l$
� � �
� % /y
OATE Month Day Year
OF JANUARY 16, 1987
DEATH
2. Piace of Death City, Town ar Location Name of (If neither, give street address)
y Hos or
Count INDIAN RIVER ROSELAND Inst� HUMANA HOSPITAL—SEBASTIAN
3. Narne of Medical ❑ Physician 1281 SOUTH HICKORYp`��ET
Certifier DR. CHRISTINE MCCARTHY, M.D. � Medical Examiner MELBOURNE, FLORIDA 32901
4. Funeral Home/ Name Address
�����er STRUNK FUNERAL HOMES 1623 NORTH CENTRAL AVENUE SEBASTIAN, FLORIDA 32958
5. Check a� The medical certification has been completed and signed. A completed certificate of death accompanies
Appro• this application.
priate �� � AUDREY was contacted on 1 16 87
�Ux . HP,��g verified that
tliis cicath w.�s fr�7m natiiral causes, that there was nn accident nor ather extamal cause of death, and that
CHRISTI:NE MCCARTY _ _ will c:omplete and sign the medical certification o(
cause of death.
��
medical certification.
was contacted on . He/she verified that
., Medical Examiner, will complete and sign the
6. Funeral Director! ignature Fla. Lic. No./Rey. No.
��i��r `�.:.,
�` 1672
g. BURIAL—TRANSIT PERMIT
C
�
Date Signed
1/16/87
P�'rmit No.1228-87-28
Permission is hereby yranted to dispose of this t�ody. ��
� A five day extension of time ior filing the death certificate (exclusive of weekends) has been requested and
yranted. If it cannot be filed withiri this time limit, a"Funeral Director/Direct DisNoser R�r�iuit" will �e tilecl
with the Local Reyistrar oi thr, County in which death occurred.
Registrar or
Sub-Registrar 5i
Siynature —
��i
Date JANUARY 16, 1987.
Issued
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
, Medical Examiner Date
Medical Exa�niner, , yave authorization by telephone to
Funeral DirectorlDirect Uisposer. Date
The Meciical 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 crernations.
Mc;thod of Disposition:
� BURIAL ❑ STORAGE
� CREMATION � OTHER ISpecify)
CEMETERY OR CREMATORY
Place of Disposition
Date ot Disposition.
Signature of Sexton 1
or Person-in-Charge )
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Uirector/Direct Disposer when there is no Sexton►
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.)
d
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THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS 91s�REBY ACKNOWLEDGED OF THE SUM OF:
FROM:
0
fS�°1
�5�. " - O • _
on this day of , 19�$ for the purchase of the following
deacribed Cemetery Lot ) upon the terms and conditions as atated hereinj
D�escription of Property:
'�.
�. �
Cemetery Lot(s)N /� B1ockN UnitN � ��L��.
� Purchase Price: '� ��Q. d � Do2lars (� /�Q. �e 1
�iy, rv � er��and conditio s of sa1e:
u�co� � �*,�-zi� �il.t.¢.l ,l a-Pa�x. �. .��./
��� �
C.� -�/��e��'.� ' �
Thie contract �ha11 be binding upon both parties, the seller end the purchasor,
when approved by the owner of the property above descr�bed.
.
I, pr we; agree to purchase the above described property on the terme and
conditions stated in the foregoing intrument:
/ ,_ .�
i
The City of Seh�stiaa agrees to se13 the abov�e mentioned property to the
ebotr� named purchaser(s) on the terms and conditions ateted in t1� abov�e
�natrument.
W� tr�ess
��G�l��° . �/�,t�: 'a J
�� � �a � ������3
�
y of Sebastian
Purchase pri ce $ � /3�. Od '
Paid •�_a d Date -2/-� BalanceS
Pai d�pa te����;��'y'-Balen�S,
Paid Dete Balance$
Paid Date BalanceS
Paid D�ate 9alsnce$
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