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QUIT CLAIM DEED
DREG, S FORM R. E. 8 !,rintcd and for sale by The H. & W. B. Drew COMMY
Sack-uuville. Florida ---I
____H --- day CI-97-FM ff (� -, .4. D. 19_;��9,
ebio Inarnture, J'ado this -------- - --- 7 of-A3 ------------------- --------
-- ------- ---
between -------- ------- P -C M-(F-Tla _(?__Iy .... _
-------- -- ----------------------------------- of the County of
INPi-A - 47�0?__1_0_A ---------------- . part--7 ---- of the first part,
-tq -------- - and State of ---- (--
and----- -- Fn_i? ------ -----------------------------------------------------------------------------
ofthe Coujity Of --- _R---- and State ----------------- part_' --- -
of
of the second part.
-rn
jV*jj'.,N1'E,8SET11, That the said party__ of the first pai,t, for and in consideration, of the su
No
-rvv E: trr _J_ -------- - Dollars,
of__ - ----------------- -----------
in hand paid by the said part-- - -- of the second part, the receipt whereof Is hereby acknowledged,
ha_.5____ remised, released and quit-clahned, and by these presents do-e-S-- remise, release and quit-
claim unto the said pa7-t__y____ of the second part, and___.).X_P_r ------- heirs and asst. ,171S forever, all the
right, title, interest, clain?, and denian-d which the said part- _T -__- of the first part ha-a---- in and to
the following described lot----, piece__ -_ or parcel - - -- of land. situate. lying and being in the County of
-ko a to-wit:
--------------- State of--- - ----- -----------------
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TO H.4 rE .4.A,D TO HOLD the same, together with all and singular the appurtenances there-
unto belonging or in anywise appertaining, and all the estate, right, title, interest and claim what-
soever of the said pa7-t---V--.-- of the first part, either in law or equity, to the only proper use, benefit
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of-- VV E: K -r Y "N'b 0 g
-------------- ------ Aimbv - _ _ -_- Dollars,
in hand pa-id by the sait part—Y---- of the second part, the receipt whereof is hereby acknowledaed,
ha_ 5____ re7nised, released and quit - claimed, and by these presents do-f—%S-- rmn,!Se, release and quit-
claim unto the said pa7't--7---- of the second part, and----h--e--r ------- heirs and assigns forever, all the
riffht, title, interest, claim, and deonan-d 7Vhirh the said part--V.___ of the first part ha-a---- in and to
the following described 7ot----, piece____ or pa7•cel---. Of I(IMI, Ritil-a.te, lying and being in the County of
....... ... .... State of -- - -J" C-. r? -( P A
--------- - - - - -- ------------------------- to-wit:
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TO H4 'E I.A,D TO HOLD the same, together with, all and sinffula-7, the appurtenances there-
unto belonging Or in anywise appertaining, and all the estate, right, title, interest and claim, what-
soever of the said part—Y---- of the first part, either in law or equity, t6 the Only Proper use, benefit
and behoof of the said part--Y---- of the second part, - ------- heirs and assigns forever.
IN TrIT.Y.ESS WHEREOF, the said part-7---- of the first part ha-A---- hereunto set--..- ------ —
hand---- and seal---- the day and year first above written.
Signed, sealed and delivered in presence of
----------- --------------- — --- - - — ------
------------------------- ----
15 C (3 A S T-1 A ff C CE tA F-- T/5- 1? 14 rt 0 IV
13
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N's C R Ei'A /f
jr
pookk
MoteA -------------------------
I IIEREBr CERTIFI", that on this day personally appetyed, before 7, an officer fficer
au-
thOrked to adMiln P oaths and. take , knOfflled�,iDl,qltsp ------- - -- ------ — --------- ---------------
oaths anti ta, c aa
"' ' , _ ___ i� 1!� � tt)
---------- --- ----- -- - ---------- - --- --- -------- - - -- ------------------------
to me well known to b the person -5- described in and who executed the f Ogoing instrument and
and voluntar-
,7 -n?,P, that------- _:_ - -- the sa7716 freely
_L _14 AN F — ------ acknowledded before
ily for the purposes therein expressed.
--- -- - _ ---- -------------------------
--------
.IJXD I F UR THER CE RTIFY. th at the
known to 7ne to be the wife of the said--------- - - - - -- -------------------------------------------------- --------------------------------
on a separate and Private examination to . and -made by and before 7,n , separately and apart
1,01, 'POSC Of
J't�7 the folleft Deed for the PU7
'ec
rl"5
from, her said husband, did acki, v7 76 that she executed t7
relinquishing, alienating and cony 1 1.6 all her right, title and inteZt, whether of dowel', home-
stead or of separate property, 8 Ut07'y or equitable, in and to , ands described therein, and that
she executed said Deed fre y and voluntarily a7ml without ny compulsion, constraint, apprehen-
sion Or fear Of Or fr ier said husband.
WITA E nz hand a - ---------
It _pd,�fficlal seal at----- ------------------------ - -----------------------------
;,an this
tate of -------
--------------------
County, -------
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-- - - - - -- -day of- ----- --------- -
(Seal) --------------------------- --- -- ----------- ---- — -------------------
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STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
.APPLICATION FOR BURIAL - TRANSIT PERMIT
NAME OF First Middle Last
DATE Month Day Year
( ypeAor print) Orva Ralph Carpenter
OF ��tt
DEA'PHeb• 23, 1978
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME OF (If not in hospital, give street address)
COIN T.Yndian River
Sebastian
NOSTITUTION Sebastian Medic Center
Attending Physician 14ichaela Tovatt 2300 ( !XAMN ceVibilb Beach, Florida J2%1051
Medical Examiners ❑
Funeral (Name) (Address)
Home Colonial Funeral home S. Indian River Drive Sebastian Florida 32958
Check A A completed certificate of death accompanies this application.
One
B ❑ Dr. was contacted on 19 .
He has assured me that this death was from natural causes and that he will complete and sign
the medical certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medical Examiners
jurisdiction. The body was released to me by
on 19 .
_1579 February 23, 1978
(Si nature
g ) (Fla. Lic. No.) (Date Signed)
Funeral
Director
BURIAL TRANSIT PERMIT Nomit 759_106
Permission is hereby granted to dispose of this body by burial, transportation out of state, storage or cremation. For
cremation a waiting period of 48 hours after death must be observed and the Medical Examiner's approval must
also be obtained.
F. A five day extension of time for filing the death certificate has been requested and granted.
Signature of� .. Date
Registrar '/j/l� ///�� / ''J,�'�_� IssuedFebruaxy 24, 1978
Method of Disposition
;0 BURIAL
❑ CREMATION
❑ STORAGE
❑ OTHER (Specify)
Signature of Sexton
or Person in Charge
CEMETERY OR CREMATORY
Date of February 26, 1978
Disposition -
Place of
Disposition Sebastian Cemetery
This permit must be endorsed by the sexton or person in charge for by the funeral director when there is no sexton)
and returned within 10 days to the local county health department.
HRS Form 326 (1/77)
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