HomeMy WebLinkAbout1-34-29Unit 1,Block 34,Lots 26 through 30 and Lots 36 through 40
Lot Number Owner Interred Year of Death
26 John L. Goodwin Dempsey Barfield 1948
27 John L. Goodwin Dottie Goodwin 1944
28 John L. Goodwin John W. Goodwin 1969
29 Mabel &Jack Mabel Louise 2003
Goodwin Goodwin/Behney
30 Mabel &Jack Vacant
Goodwin
36 John L. Goodwin John L. Goodwin
37 John L. Goodwin Ida Mae Goodwin 1944
38 John L. Goodwin Charles Goodwin 1966
39 John L. Goodwin Olive O. Goodwin 1977
40 Mabel &Jack Vacant
Goodwin
A legal indenture in file signed by Tessie G. Hart, dated August 27, 1982 granted
ownership of Lots 29, 30 &40 to Mabel L. and Jack E. Goodwin for the sum of "love
and affection".
I
BLOCK 34, LOTS 29, 30, 40, UNIT #1,
MABEL L. GOODWIN/BEHNEY & JACK E. GOODWIN
P.O. BOX 902
SEBASTIAN, FLORIDA 32958
RECEIVED OWNERSHIP OF THE ABOVE LOTS ON DEED #0502, 8-27-82
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Name /k1rJL: G' E. N
5ex V'
Unit l
Block -3 /
Lot a /
Date of Mark-out il,/0 6/D 3
Date of Burial // /0 8 /0 Time a 00/.2
Name of Funeral Home .•',_,J ./ .(t_A) Ks-
Authorized by
154-rrcvvci., rfus / ' — day of fld=-e , 1982, by ��' e, -
�" Pat Flo d, Jr. , Mayor
City of Sebastian,Fla.
Notary Public,State oreSfApr'I 16,1983
My Commission
ap
By&Miica& It•&Casualty COmpanY
FLORIDA DEPARTMENT OF / ~ 8 3 t 7
HEALT State of Florida, Department of Health, Vital Statistic 0 b
APPLICATION FOR BURIAL-TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Mabel Louise Behney Death Nov. 5 2003
2. Place of Death City,Town or Location Name of (If neither,give street address)
County Hosp.or
Indian River Roseland Inst. Sebastian River Medical Center
3. Name of Medical Address Phone Number
Certifier Syed Mahmood.,11.D. 77511 Bay Street
nMedical Examiner IPIPhysician Sebastian, FL 772-589-3000
4. Name of Funeral Home/Dc c�—dal Address Ha. Lic. No./Reg.No. Phone No.(Area Code)
Establishment 1623 N. Central Ave.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check a. 0 The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ii, Tina was contacted on 11/5/03 .
He/she verified that this death was from natural causes,that there was no accident nor other external cause of death,
and that ur. Mahmood will complete and sign the medical
certification of cause of death within 72 hours.
c. ❑ was contacted on . He/she verified that
, Medical Examiner,will complete and sign the
medi certifi 7 cause of death within 72 hours.
6. Funeral Director/ S' na F.E. No./Reg.No. Date Signed
Direet-Bispe3er, 1862 11/5/03
B. BURIAL-TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-03-01160
El Afive(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 funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within
72 hours.
❑No extension of time for filing the death certificate has been requested.
f3ragi:tr r rir—t Date Date Certificate
Subregistrar Signature — / `� (Issued: 11/5/03 Due: 11/10/03
C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number: 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.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
- / ,.,
BURIAL El STORAGE Date of Disposition // /13 !?
CREMATION OTHER (Specify)
Signature of Sexton
or Person-in-Charge /4/7/..1 i j. r "}-;
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: L call H istrar
/7210_,
CITY OF SEBASTIAN
CITY CLERK'S OFFICE G�j 2 `�
RECEIPT I
Name ` 77.444001.-4‘.1 44.-)11 Cash
Date // //et? eck
No. Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC/Code of Ordinances
001501 341930 Election Qualifying Fees
601010 343800 Cemetery Lots
Lot/Niche Block ,Unit
001501 343805 Cemetery Fees 'A7,5 d1
L `
Total PaKa Gd
Initials
White-Dept.of Origin• Yellow-Finance •Pink.Applicant