HomeMy WebLinkAbout1-38-23�
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BLOCK 38 Lots 23 & 24 Unit 1 A�ditional
Elizabeth T. Palmer and/or Gregory B. Palmer
941 Louisiana Ave.
Sebastian, F'lorida 32958
John Palmer interred - Lot 23, Apri1 4, 1984
�"l�.z�l,�� ��.im �t' i � �-e�'rr,.,�C"- �o •� ;7<L ��� 7��� 1
Paid by CEMETERY Receipt No. . . , 3 6 9, . , _ , , , , , Dated . .4�? i 84 . . . . . . . . . . . . . . . . . . . . NO.
List Price � . .300 : 00 . . . . . . . . Maximum No. Purial S�ces . . . � . . . . . . . . . . . .
Net Paid a , . 3 00 : 0 0 . . . . . Monument permitted , , FZ a t . . . . . . . . . . . . .
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Elizabeth T, or Gregory B. Palmer
Lots 23 & 24, Block 38, Unit 1 Additional 941 Louisiana Ave.
(Data above ffiis line for C3ty Record only) Sebastian, Florida 32958
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A. (Type or Print)
1. Name of First
Deceased ,JOHN
STATE OF FLURIDA
EPARTMENT OF HEALTH & REHABILIT�E SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL—TRANSIT PERNIIT
Middle Last
CARROLL PALMER
�_ r,�,.�1 �;: % �.. �.` � fi
DATE Morith Day Year
oF �tarch 31,1984
DEATH
2. Place of Death City, Town or Location Narne of (If neither, give street address)
County Hosp. or
Indian River Sebastian �nst. Humana Hospital
3. Name of Medicai � Physician Address
Certifier Mohammad I d rees , M D ❑ Medical Examirier � � 5 NW Pa 1 m Bay Rd ., Pa 1 m Bav , F 1.
4. Funeral Home/ Name Address
Direcc DisPoser Strunk Funeral Home. , 734 North Central Avenue. , Sebastian
5. Check a[� The medical certification has been completed and siyned. A completed ceriificate of death accompanies
Appro- this application.
priate b X� `_�-.—_1dK�ees-�
Box was contactu�i on _i1�2 . He/she verified that
this death was from natural causes, that theru was no accident nor uthei external cause of death, and that
He, Dr. Idrees will complete and sign the medical certification of
cause of death.
c� was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medical certification.
6. Funeral Director/
Direct Disposer
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B.
C
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Sigr ture Fla. Lic. No./Rey. No.
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BURIAL—TRANSIT PERMIT
Date Signed
April 2, 1984
Permit No. � ���—R4— � �1
Permission is hereby granted to dispose of this body.
� A five day extension of time for filing he death certificate (exclusive of weekends) has been requested and
granted. If it cannot be filed within thi�time limit, a"Funeral Director/Direct Disposer Report" will be filed
with the Local Registrar of the County i which death occurred.
Registrar or
Sub-Reyistrar Siynatu
Signature
ur
�sued Ap r i 1 2, 1984 ��
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
Me�'ficel Examiner 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 reyuired for all cremations.
Method of Disposition:
�URIAL ❑ STORAGE
� CREMATION � OTHER (Specify)
Siynature of Sexton )
or Person-in-Charge ►
CEMETERY OR CREMATORY
Place of DispositioT
Date of Disposition
41'l�
This permit must be endorsed by the Sexton or person-in-charye (or by the Funeral DirectorlDirect 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.)
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` , THE SEBASTIAN CEMETERY .� �
;�� City of Sebastian `� ' 3 ~�
Sebastian, Florida
RECEIPT IS XERE Y A OW DGED OF THE SUM OF:
%--'""'' Dellars l$ �
__ .
FROM:
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on this �� day o ,•1�� for the purchase of the following
described Cemetery Lot s) pon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot (s) # v�� "c�-� B1ock# �� Unit# J Q�� _
Purchase Price:_S�� �v Dollars ($�D�• � j
� � Terms a/�� on itions f s Ie:
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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 des
stated in the foregoinq instru�ment:
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.
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Witness