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L1NiT . �NE ; I ,. � • _ _ ; � i � . � , i �' � I i . ; � --I "� � j � � -± _ xy-��c � o :_ �-�- - � � ...}' u.... ....... �.... .�.. y �. rca.cu' � � _" a . . . . .,: ... _ . y .. _..-.. . . . , .. . � ..�. �. .. .._._ _.." .:� .� ... . . i . � dEeC� �182 Paid by GeneraL Receipk I�To. �? ..���sh �.: Dated a�l��?2 ••• ••••• 1�1r8. Pierre Jelis � 2 453-Columbws St, SH �1 List i'ric� $. .. 15 0. D0, , , ItiuxImum No: Burisl spaces .. .. ... p� 0, Box 533 Dtacount $....... .. . .. Totnl erea in'eqnare teet :....... Sebastian, Fla. Net Paid $. . .15 0. 00. . . . . . Monument nennitted . . . . . , . .. , . . . . . . . . . . . Lo t $ lwl & 12 r B lk . 35 _ Unit � �� (Dats above this line Yor City Itecord only) Name t`�" 1 , .°,z>_� Unit '� �-� , _,.,. Block Lot -.„,�.,- , ��. . 4 f ,. �.. p`... , . , �` 1 .' , t.. .. ...... ~ .. ' f`J �.,� Date of Mark-out ' ' � F /''�.rrr. . d.d�" .:.� v.i� Date of Burial �F s�� �" � � Time �,.A.�. _ Name of Funeral Home r' f�, �" �` A � ;• �r, Authorized by _� r' ' '. ` , �.:_..._.� I� _____ f�� 0 NEW YORK STATE DEPARTMENT OF HEAL� Vital Records Section Name le % Burial - Transit Permit Last Female Date of Death Age If Veteran of U.S. Armed Forces, 04-20-200L,, 95 War or Dates No Place of Death Hospital, Institution or Center City, Town or Village West Ba,bylon, NY Street Address Berkshire Nursin & Rehab. Manner of Death � Natural Cause � Accident � Homicide � Suicide � Undetermined � Pending Circumstances Investigation Medical Certifier Name Title 1 L�6L� N. 5th Ave. Death Certificate Filed City, Town or Village �Burial Date ❑�ntomhrr.ent AddresOs ❑Cremation Date � Removal and/or Address Hold Q Transportation by Common De Carrier � Disinterment Da � Reinterment Da� Permit Issued to Name of Funeral Home Address Address , Ba.y Shore Bab.ylon NY 11706 District Number 5150 Cemetery or Crematory Sebastian Cemeterv Place Remc and/or Held Point of Shipment JFK Melbourne FL Cemetery Address Address Johnstons' Ulellwood Funeral Home 305 N. ti�Jellwood Ave., Lindenhurst, NY 11 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Strunk F�aneral Home Register Number 1 /�:8 � Number 1623 l�t. Central Ave., Sebastiany FL 32958 Permission is herek�y granted to dispose of the I�uman remains deserih�ea above as in :iaate�. Date Issued 04-22-2001: Reegis��� of Vital Statistics � �- (signature) District Number 5150 Place No. Lindenhurst, NY 11';�j%-2597 I certify that the remains of the decedent identified above were disposed of in accordarce with this permit on: Date of Disposition '� ,�� � Place of Disposition S'" ,�2$'�� �,�� �"�,� • e r (add`ress) �W �� � v��// � S� �� Name of Sexton or Person in Charge of Premises 0 Signature DOH-1555 (02/2004) �.r�a��r�17►z (section) i•. (�ot � (p�ease prmt) Title SC�X�s� (gr! a e r (over) ___ -- . . -._ __ c__- --- _ j� o.�,kh•r. ,_ _� _ �a �. �.t,v� � --; . - fi�.Q. 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I _ CITY OF SEBASTIAN CITY CLERK'S OFFICE 2 7 51 RECEIPT l �/ �� � Nam - � �v1-��cx�-' ❑ Cash �,,� T" �1,��,� D e �71�%�� ���kl��.� No. ��'f Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lois LoUNiche 81ock .Unit� 001501343805 Cemetery Fees / '� • �� l� � l� �itJ.�/-<��1f i�, ��+ `--�.� i/.."�`R-� G�f � �:� . � �'�r � . � ToWI Paid �-�' G� J initials White - Dept. of Origin • Yallow - Financa • Pink • Applic�nt � �.. ' EXPVINATION AMOUNT 7-2/Z1O JOHNSTONS` WECLWOOD FUNERAL HOME WC. 2 9 3 O O 305 NORTH WELLWOOD AVENUE LINDENHURST, NY 11757 . PAY 00 AMOUNT S�.V Cs I� �y �`1 � �.7J n OF OLLARS DATE . ORDER OF DESCRIPTION / �.DPMorganChaseBank �LINDENHU SOONY �E� �E ��'0 29 300i�' �:0 2 i0000 2 L�:89 7 100 2 39��' CHECK CHECK AMOUNT NUMBER �93oa � � o0 1 QOS J 4 c�s. S .fF` C� �� 9 C'v ;� � �