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HomeMy WebLinkAbout1-37-30' , _ ; : i : LJ : _ ' S � �'�.`.�' �' 7 £ - . .; � �. �4Cc, t�P�`� 5 � � _ � (. / 3 , � ���� � 7 f Z � � ' �'� "' � n ��- , � � � � � � �' �� �` � : , �� � , . r/ � ; �, � � �a �� � J �' � �, ' 0 �� �� 4. , � i '� � ie � � k� _ �y � . /L , :��- a� � I �`"3 ��� w�� ll `' � `� U �` , � � : �� �� � � ,� ��� � � y� �� �' � �°\�' 1�'� �" - , , `_ : � f9 � g �t - J1 ; �� � � ,$�3 � . 1 . ��`� t� �.� I . . � �-` `� t�' '� '��C � � - ��� - � L� °'��� �� ' � . a �� q�a� � ' ��` ✓ z'= w, Z � y� , 3� 3i- �QJ ,r' � � � �G � � � '°� ; t'� ' ��� 1 � � � �� � � r,�� aw �' �, - C'� �.'� , -f � ... M f Name �i °r' �; ,�-.-� ; ! ,�s Unit � � �� � Block � � ;� Lot � `- �.. :1 ,�.�` � - - . Date of Mark-out " � � �°� ' �'�r "` r� �'' d , �";f / � ' •` � !.� t;,` � � ir^`. �,, A � M � � � ; , . < , Date of Burial •�' ' �` `' � Time � � �, Name of FunE Authorized by ��r=� `�000�o °;� o�, � a ��o�° ��,�'msu �r�pw 3 n �-"3 fD$°wx� a� ¢ �o a w °� ��"^a � �g�m O�r�rO �� co — "• w ,�. ��� � �' � �� �� m — rt -�. mo � — �O N � (D � � �c�'AC�.�u� ����'���� ryf7�(DyNO.A o sc:� �o mm �v ;� �' y ,tn.F oo !n c, � _ m v, -, n • �„r C •O ±'i3i,a��< � .,� ,.' _? x-_ � � =?aT �� �co � r'��,�' �o�s =co `� aa� a� � �ar�i �:�� �a+ a�aaaoa� m � o = •..-noo•••� o3•c�m°—'osvo�o-*p,�rac��u, 3a�>>a'*>? y�' ��cm� cu�u;'•_.�.m �^��+a`�3a- <, • y�AN3'-°w—�v�ir"c�o>>:�oo� �.�p �y�° �p � � p�' -Iui �?DSr�re Ztn �-• W C, Xpi � '� � W ��-F�'�NO.W �-�i�Vl �!D A QO.� A aiu`DfQ1Q�='•9�'�0'�o��y �o�aa�?y�.�^��3�c�c.w iomc`�'o�s�"n�,o�amc�,�•�rc � �Q��o r�' r.��Y11/1 O � �� w�g��3�� �a�.a�e�-. � s v� o� V-3 W a; � �o�oa c'�=� o ��°��,p° Ac'��'m��,c?am a� naQ-� �— ��,tn Zw p r�� ?Z� v�i� °m =�a fD� n' ��� �AT y� � rt�o. O w+ e�'> '�o-« a.m�� �f9 WS� 77 T� 7C� lD..fD A� o�>> x �_r°�'a�ce oa�� 9c�� � o��° 7 ��`�� 0 `"�mm a��a ZCO►„ ��,�N �2 � �OC _w�a 3 � r► �p � V. �o s a _ y y��,�� � E-"' ? a � o, �o � -�i 7 � �Q d��� 3�0` rttOr0 fD �p ' e �°oeoo O.Aa- N ��0 �� r A � � � -- FLORIDA DEPARTMENT OF HEALT (TYPE) Name of Deceased First State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT Middle Last Joseph W 2. Place of Death City, Town or Location County i ndian River 3. Name of Medicai Certifier MiC�e18 SCOtt, nMedical Examiner � 4. Name of Funeral Home/Direct Disposa Establishment Roseland .D. Kolmel Name of Hosp. or Inst. Date of Death (If neither, give street address) 8095 12 1�60 36th Street Vero Beach. FL Address 1623 N Central Ave /- �7-�a Month Day Year June 9 2004 one Number 772-562-7777 Fla. Lic. No./Reg. No. Phone No. (Area Code) Strunk Funeral Home ( Sebastian _ FL � I � 22$ I 772-589-1000 5. Check a. � The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b� Mellssa was contacted on 6/9/04 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. SCOtt will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director/ ,�y�� a. c � c. � was contacted on certific 'o - ause of death within 72 hours. Si F.E. No.lReg. No. 1862 BURIAL - TRANSIT PERMIT He/she verified that , Medical Examiner, wili complete and sign the Date Signed 6/9/04 Permission is hereby granted to dispose of this body. Permit No. 1228-0�-0232 � A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funerai director and will not be able to complete the medical certification of cause-of-death section ot the death certificate within 72 hours. �No extension of time for filing the death certificate has been requested. RegTSh�aror-'• Date Date Certificate Subregistrarsignature �,,�,BJ„[/M.,� ���.�-a.�-� Issued: 6/9/04 Due: 6/14/04 Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Date . Medical Examiner, , gave authorization by telephone to Funeral DirectodDirect 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 alt cremations. Method of Disposition: �/ BURIAL �CREMATION Signature of Sexton j or Person-in-Charge � CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery �STORAGE Date of Disposition � �� S�p lj/ �OTHER (Specify) 0 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 County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number 5740-000-0326-2) Pink: Local Registrar � I � I� I ! ', ! ', � � I�, � jl i �,i i j I� ' ; i i '� � � � i �I � j I � j , I , � , I ; : ' i i , , , ' , . ,. , . � , ;. ,_ , � i i � , � � , , ,_ , �._ ,. , , , , � . � ; , i ' I � � �'' � � r , � i �� ,�� �� . ���� I ' i � , F, ��i� � , � , �' %1 � , �.. �� , � ' f�C �� 'b i��'�j � I ' � , I , ! �� �, f,`v`� �� i�, , I�` II ' I I � i4� °0��i �� � ! � !,Q !� � , ',, ���Cd`��k �� II � � � ! �, ��' � � I I� , .0`' ^�1"; ; � �'-- ''; � , I '� , � ao ! I ; � , '� �/� � ; `_ I, � I , ,V�� I � ;I i i �p � � %� ;�1 , j , ' � � � � ''; �, � � � ,.7" � � , � � i �� � ' � , i�� ! � I I , , , — i J1 I , , � , � �, � , ! . � '�,,. � i'C � I i �' � , ' ' I �O ', i, „WJ ' i 'i , , , � � ;� , � � �.�' ; ; If ; j. - ! , i , , i i , � � , ' I !, , � ', ' ' ' , ! � : � ' .w d N � � m I O , � . '0,�. '� s m � i T m 3 t'f O • � 7 � � O �a � 9 � � d r p,�V1 � ��r� �'i o� 0 � 0 w A W O (J1 0 0 °o 0 0 0 0 cn cn cn a ° o 0 0 0 � 0 W j A � N O O W � N O � O O O � � � � � � � �(�pp � � N � Ci � N -1 N � � � y � � `� � � d y x N Q, � � � N y�� .�' � N � a s� s m = N �' m N C�/ � � C 7 , , � 0 � a � a n �� � m� �y V! W O y T � T � � Z m � � . • DEED #448 THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF TNE SUM OF: Three hundred and no/00************************** Dollars ($300.00********) FROM: Joseph Ko.ZmeZ • : . . ��] Sebastian, Florida 32958 on this 22 day of May , 1981 for the purchase of the following described Cemetery Lot(s) upon the terms and conditions as stated herein: Description of Property: � Cemetery Lot(s)# 28.29,30 B1ock# 3� Unit# 1 Addition Purchas� Price: Three hundred and no/oo***** mllars($ 300.00*�*). Terms and'conditions of sale: Paid by cash in fu11. 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 se11 the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. � City of ebastian --�-��%-C.� Witness