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Date of Mark -out
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Date of Burial
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State of Florida, Depart of Health and Rehabilitative Services, Vita 0tistics s�
APPLICANAN FOR BURIAL — TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
Velma Fay Wade DEATH June 8, 1997
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Micco Inst. 9210 Tucker Street, Micco, FI 32976
3. Name of Medical Medical Examiner Address Phone Number
Certifier
Noor Merchant Physician 7744 Bay Street, Sebastian, FI 32958 561- 589 -0879
4. Name of Funeral Home/ North Central Ave. Fla. Lic. No. /Reg. No. Phone Number (Area Code)
Direct Disposer
Strunk Funeral Home Sebastian, FI 32958 1228 561 - 589 -1000
5. Check
Appro-
priate
Box
a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b Julia was contacted on 6/9/97 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 Dr. Merchant will complete
and sign the medical certification of cause of death.
medical certification.
was contacted on . He /she verified that
, Medical Examiner, will complete and sign the
6. Place of Sebastian Cemeter sta cemeter / Removal
Final Disposition: r ory - n e ty: I n ian River from state Donation
7. Funeral Director/ ature F.E. No. /Reg. No. Date Signed
la+cort Q*gPn, _ 1862 6/9/97
B.
BURIAL — TRANSIT PERMIT
Permit No. 1228 -97 -0268
Permission is hereby granted to dispose of this body.
❑ 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 filing the death certificate requested.
ReqWFaF OF -T Date Date Cert' is e
Subregistrar Signature — z--= -= `T'�- � L--l�� Issued: Due:
C. 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 hours after
death is required for all cremations.
D. CEMETERY OR CREMATORY
Methods of Disposition: Place of Disposition CA km -
91BURIAL ❑ STORAGE Date of Disposition / 497
_
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge) '
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 Form 326, Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740- 000 - 0326 -2)
0 0
M
THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS BEREBY ACKNOWLEDGED OF THE SUM OF:
--- vo11ars
FROM:
I/
on this . _�day of _,Gt/k , 1981 for the purchase of the following
described Cemetery (s) upon the terms and conditions as stated herein;
Description of Property:
Cemetery Lot (s) #/Z /S".l /(o Block# �5 / Un 't# 2- a,4 L, ,
Purchase Price: t/ i Dollars($
Terms and conditions of sale: LQ may` i
This contract shall be binding upon both parties, the seller and the purchaser,
when approved by the owner of the property above described.
't
I, or we, agree to purchase the above described property on the terms and
conditions stated in the foregoing intrument:
The City of Sebastian agrees to sell the above mentioned property to the
above named purchaser(s) on the terms and conditions stated in the above
instrument.
Witness
Cit o Sebastian
Purchase rice $ DD . 0 D
PaidDate v BalancesOD o
Paida?O0 q-0 Date / Balance$ ligo O
Paid �'n O Date Balance$ -6'
Paid Date Balance$
Paid Date Balance$