HomeMy WebLinkAbout4-44-10 CEMETERy Receipt No ..... '
i. ist .... .....
Net Paid $ 650.00
% ........ Oared ~9¢.p.~¢mb.e,tl ..~9.,..i 7 No.
? Lots 9 & 10
Ma ~immn No. Barhl Spaces ...... :~. ......... Blk.44,Un.4 1138
Monumentpe~tted ....~:~.[ ............. Howard & Dorothy Morrison
177 Richard St. (Whispering
(~ta above mi~ line for Oty r~rd only) Sebastian, F1. Palms )
NO.
TJHS ~NnENTUng ~XBm ~ ~9th da~, o~ September ~
................................................................... ~. D., 19...
I~oward and DorothX Morrtson
.......................... 37...¢3~.~.:~J .S.~.: .... ~?}5~pertng PaZms) Sebastian, F~ 32958
ot th~ co~,t~ ot Indian R:Lver Florida
............................................. an'l State of
Tl~at the Grantor for and ~ ~n~dem~on of the sum of S ...6 ....... 50.0.0 .... ......... .. to it ~ h~d paid, the re~ipt whereof is herewith
.~,o~ot(~)~" ~..~..l~o~, 44 ,UN~Z
4
............... ....... of Sebm~t~tn m~tidpal ~metury as per Phi Number 1 thereof te~)rded ~ P~t
WITNESS h[~IE~OF, The smd p~y of the fkst p~ ~s mused this ~tsrrument to be executed ~ its name md on ks beh~ by its Mayor
City Clerk .............
.. '-,~..f.. · :~- ........ t/Lx...~ ...................
//
!
CITY OF SEBASTIAN, FLORIDA
State of FIo~lde, Depar~nt of Health and Rehabilitative Services, ~l~tatlstlcs
APPLIWON FOR BURIAL -- TRANSIT PERMIT ~ '
(Type or Print)
1. Name of
Deceased
First Middle Last DATE Month Day
OF
Dorothy Valetta Morrison DEATH 08/12/91
Year
2. Place of Death
County
3. -I~a"~e-~f I~di(~
Certifier
Direct Disposer
Strunk Funeral Homes, P.A,
5, Check a []
Appro-
priate
bX[]
c []
City, Town or Location Name of (If neither, give street address)
Hosp. or
Inst.
=,.o,~ ] ..,,4 J Medical Examiner ........ /~1~1~ ........ Phone Number
~-'~Physician 13865 U.S.# 1
'Address ............ ] Fl*a;£'~c"~ NoT,'Ti"e~:'No.[ I:q'~'~ ~l~l~eF(~'~e~a Code)
1623 Norf. h Cenf. ral Avenue /
Sebastian, F1 32958 / 1228 (407)562-23~0
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
.u.[che!!e was contacted on 0~/~_2/9! within 72
hours after death. He/she verified that this death was from natural causes, that there was no accident
nor other external cause of death, and that 1L~r.h~f. ghn~j.. M. 13. will complete
and sign the medical certification of cause of death.
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medical certification.
6. pisceofseb~stian Cemef.,~rv In state cemetery/ Removal
Final Oisposi~(~n: . ?~ ~. ~ cm~p)~tery - name/county: Indian River ~ from state
7. Funeral Director/
~ Donation
Date Signed
0_~!!2/91
B, BURIAL -- TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-91-0364
[] A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct
Disposer Report" will be filed with the Local Registrar of the County in which death occurred.
[] No extension of time for filir~he death certificate requested,
Subregistrar Signature . Issued: ~ /,~ ~;~// Due:
AUTHORIZATION for CREMATION, DISSECTION or BURIAL--AT--SEA
Signature , Medical Examiner Date
or
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 houm after
death is required for all cremations.
Methods of Disposition:
· BURIAL
[] CREMATION
Signature of Sexton )
or por~_.,~ )
CEMETERY OR CREMATORY
Place of Disposition.-.,.-~.~-~.~..
[] STORAGE Date of Disposition
[] OTHER (Specify)
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 HRS County Public Health Unit in the County where disposition occurred.
HRS Fcrm 326, Feb 89 (Replaces Oct 87 edilicn which may be used)
(Stock Number: 5740-OO0-0326- 2)