HomeMy WebLinkAbout3-73-04State of Florida, Department of Health, Bureau of Vital Statistics
—�— BURIAL TRANSIT PERMIT
HEALTH DATE PRINTED: April 20, 2018 TRACKING NUMBER: 2018067659
1.
Name of Deceased
GLENN MARTIN FAHEY
Place of Death - County
INDIAN RIVER
DECEDENT INFORMATION
Date of Death
April 17. 2018
City, Town or Location Name of facility, or street address if not a facility
SEBASTIAN
Name and Address of Funeral Home/Direct Disposal Establishment
SEAWINDS FUNERAL HOME F073380
735 SOUTH FLEMING STREET
SEBASTIAN, FLORIDA, 32958
349 MIDVALE TERRACE
Fla. Lic. No./Reg. No. Phone Number
F073380 (772)589-1933
Funeral Diractor/Di.oct Disposer - Fla. Lic. No./Rog. No.
KATHLEEN KAUFFMAN F047386
Medical Verification Statement
Office Staffat the certifying physician's office, was contacted on 04/18/2018 by the funeral director listed above; he/she indicated
that STARLEEN CELESTE SCHAFFER, certifying physician, will complete and sign the medical certification of cause of death within
72 hours.
2.
BURIAL -TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: April 1 , 20180-5104
�— Date Issued: April 18, 2018
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 19 Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: SEBASTIAN CEMETERY B
Method of Disposition: BURIAL Date of Disposition: 1(1,3
V// a
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V-1.011, Florida Administrative Code