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STATE OF FLORIDA
*EPARTMENT OF HEALTH & REHABILITWE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL — TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
HENRY MEYER DEATH Sept. 17, 1982
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. X1K111XKX Vero Beach CareCenter
3. Name of Medical 9j Physician Address
Certifier Muhammad Farooq, M.D. ❑ Medical Examiner 777 37th Street., Vero Beach, F1.
4. Funeral Home / Name A` XIIKKX Florida 32958
Direct Disposer Strunk Funeral Home. , 734 North Central Avenue. , e as f f i an
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
Bute b nPhh i P, Spc I was contacted on 9/20 . He /she verified that
Box this death was from natural causes, that there was no accident nor other external cause of death, and that
Dr Enron will complete and sign the medical certification of
cause of death.
c ❑ was contacted on . He /she verified that
Medical Examiner, will complete and sign the
medical certification.
6. Funeral Director/ igna ure Fla. Lic. No. /Reg. No. Date Signed
Direct Disposer
_ 2088 Sept. 20, 1982
B. BURIAL — TRANSIT PERMIT 1228 -046
Permit No.
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. If it cannot be filed withi this time limit, a "Funeral Director /Direct Disposer Report" will be filed
with the Local Registrar of the Co my in which death occurred.
Registrar or Date Sept. 20, 1982
Sub- Registrar Signatu Issued
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL -AT —SEA
10
Signature
or
, Medical Examiner Date
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.
Method of Disposition:
�URIAL ❑ STORAGE
[]CREMATION ❑ OTHER (Specify)
Signature of Sexton)
or Person -in- Charge )
City Cl
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
Date of Disposition 9-20 -82
Sebastian, Florida
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 County Health Department in the County where disposition occurred.
HRS Form 326, APR. 81
(replaces previous editions which may be used.)
Henry W. and or Deca Mae Meyer
207 Poinciana Street
! by CEMETERY Receipt No.:... 317........ Dated ... Saptember- 26 ,..1982..,, Sebastian ,Fla . 32958 , `! 0 4
NO. F,l l
Price $415.a. Oja . SACH., F956L00 Maximum No. Purial Spaces... 4... ............. BLOCK 49, Lots 5,6,7,8, Unit #2 Add.v'
Paid $ 600 .00, , . , . , .. , . Monument permitted ..... FI a t ...... _ _ .. .
DEED #504
��.�� (Data above thL Une for City Record only)