HomeMy WebLinkAbout4-35-10 F1pR1D�aDFI'ARC61E4TOF ,. State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED:December 26,2013 TRACKING NUMBER: 2013182231
1. DECEDENT INFORMATION
Name of Deceased Date of Death
JOSEPH EDWARD FLUMAN December 24,2013
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
ORANGE ORLANDO ARNOLD PALMER HOSPITAL
Name and Address of Funeral Home/Direct Disposal Establishment Fla.Lic.No./Reg.No. Phone Number
STRUNK FUNERAL HOME-SEBASTIAN F041870 F041870 (772)589-1000
1623 N CENTRAL AVE
SEBASTIAN,FLORIDA,32958
Funeral Director/Direct Disposer Fla.Lic.No./Reg.No.
TIMOTHY W.MARVIN F022789
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.
n Permit Number: 2013-F041870-5169
Q G/ / �� • t Date Issued: December 26,2013
Meade Grigg,State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: SEBASTIAN CEMETERY
Method of Disposition: BURIAL Date of Disposition: �,�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
CITY OF SEBASTIAN
CRY CLERK'S OFFICE ` n -'
RECEIPT 4 0 0
Name n k_ �� M t!ti�1 ❑ Cash
Date I - ( `T [Check# " 319
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 j C ,Block 35 ,Unit
I 001501 343805 Cemetery Fees /36,00
Total Paid /SU.to
Initials
White-Dept.of Origin• Yellow-Finance •Pink-Applicant