HomeMy WebLinkAbout4-09-20State of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
HEALTH DATE PRINTED: October 17, 2016 TRACKING NUMBER: 2016160527
1. DECEDENT INFORMATION
Name of Deceased Date of Death
HOWARD E BROWN October 16, 2016
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
BREVARD PALM BAY LIFE CARE CENTER OF PALM BAY
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.
GARY D. EVANS F065074
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: 2016-F041870-5180
— Date Issued: October 17, 2016
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:
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
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CITY OF SEBASTIAN 10390
ADMINISTRATIVE SERVICES RECEIPT
Name url K ❑ Cash n
Date���' �6 Check # /�7 S«r
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit
001501 362100 Taxable Rent
001501 362150 Non -Taxable Rent
450010 369900 Airport Badge
001001 218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 329200 Site Plan Review
001501 329300 Subdivision/Plat Review
001501 329100 Zoning Fees
(yrsrr 4 8iK y��Lj*r:�a
4a7ls Total Paid O
ials
Security Dep Held - Amount $ Check #
White - Dept. of Origin - Yellow - Admin. Svcs. - Pink -Applicant
Name .1
Unit—
Block—
Lot
nit_Block_Lot
Date of M
Date of Burial , /22 /i 6 — —Time / 1ILOA" &0
Name of Fune
Authorized by
cmr of
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HOME OF PELICAN ISLAND
Certificate No. 2105
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
John H. Brown
(name)
626 Fleming Street, Sebastian, FL 32958
(address)
in and for consideration of the sum of $2.100.00 is entitled to full interment rights in
the Sebastian Municipal Cemetery for the following plots:
Unit 4_ Block 9_ Lots_18,19, 20_
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 30`h day of November, 2006.
OF~b;~BASTIAN, FLORIDA
A
A Minner ~ Sally A. Maio,
City Manager ity Clerk
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