HomeMy WebLinkAbout2-48-02----- ------- --
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Name
Unit
Block fis
Date of Mark -out /A a
Date of Burial / / `j� Time
Paid by General Receipt Na ..1,86, ... Dated.. April 30 1980 , , , . ,
Last Price $.400,.00 , , , , , , . , Maximum No. Burial spaces ...4....... .
Discount $ ..... - ............ Total area in square feet ................
400.00........ Monument permitted ... .�JAt .............
Net Paid $.......... 1?e'
(Data above this line for City Record only)
s� *Z1,0,6
Donald L. Cole
Cor Gibson & Berry Sts
P. O. Box 62
Roseland, Fl 32957
B1k 48 Lots 2,3,4 & 5
Uni t 2
DOLE, DONALD. L. DEED #385 & �T
Corner Gibson & Berry Sts #406
Roseland P.O,. Box 62
BLOCK 48 Lots 1, 2, 31 4 & 5 Uni t
Kenneth Cole transferred from Blk 7 Lot 12 to
Block 48 Lot 1
+COI COle i�►xi' i� �3 �i-
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State of Florida, Departmen of Health and Rehabilitative Services, Vitat istics A a
y f,
API BURIAL — TRANSIT PERMIT
A. (Type or Print) N p2
1. Name of First Middle Last DATE Month Day Year
Deceased Richard Edward Cole OF 12/28/93
DEATH
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst.Sebastian Hospital
J. Name of Medical Medical Examiner Address Phone Number
Certifier 132 U.S. #1
David DePutron, D.O. Physician Sebastian, Florida 32958 (407)589 -6888
4. Name of Funeral Home/ Address Fla. Lic. No. /Reg. No. Phone Number (Area Code)
Direct Disposer 1623 North Central Avenue
Strunk Funeral Homes, P.A. Sebastian, Fl 32958 1228 (407)562 -2325
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box b 10 was contacted on 12/30/93 within 72
hours after death. He /she verified that thibapItg b % %Tmornaturg Uiuses, that there was no accident
nor other external cause of death, and that 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. Place of a as Ian Uemetery In state c etery/ Removal
Final Disposition: cremat - name /county: Indian River from state Donation
7. Funeral Director/ ure F.E. No. /Reg. No. Date Signed
Direct Disposer - 1672 12/30/93
B. BURIAL — TRANSIT PERMIT 1228 -93 -0585
Permission is hereby ermit No.
y 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 thjldeath certificate requested.
Registrar or - Date 2 q., Date Certificate
Subregistrar Signature Issued: ����/ -/ Z Due:
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —S
Signature Medical Examiner Date
or
Medical Examiner, gave authorization by telephone fo _
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
12 BURIAL ❑ STORAGE Date of Disposition t R
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton ) //,Zf
o r Person -in- Charge) �yJ �.��.0
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)