HomeMy WebLinkAbout2-45-02� -� -- _____�L
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Name
Unit
Block
Lot .2
Date of Mark -outer 2 -?A2
Date of Burial 12- 3 i Time /:,30 02 M
Name of Funeral Home '5ed'► s T"- "' 1 E
Authorized by
Paid byfigceipt No. ....23.1 ... Dated... February 10,..1981
List Price $ 200.00 Maximum No. Burial spaces ............
Discount $ .................. Total area in square feet ................
Net Paid $..2DO..00 ....... Monument permitted .......... f12at .....
R & R sent with deed t0 Pottinta above this line for City Record only)
Deed #437
Taylor, Harold
802 Essex Lane
Sebastian, FL 32958
Block 45, Lots Z and 2
Unit 2 addition
State of Florida, Depart110of Health and Rehabilitative Services, Vita istics .� . iJ
,_�
APPLICATION FOR BURIAL — TRANSIT PERMIT Z X
A (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
HAROLD TAYLOR DEATH 08 / 13 / 93
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
"nranap_ Winter Park Inst. Winter Park Memorial Hospital
3. Name of Medical
Certifier
Dr. Waldheim
4. Name of Funeral Home/
Direct Disposer Carey
5. Check
Appro-
priate
Box
Han
a E] b
c El
Medical Examiner Address
402 Lake Howell Road, Maitland, Florida 32751
Address
Phone Number
(407)
628 -4312
Fla. Lic. No. /Reg. No.1 Phone Number (Area Gode)
Hand 11350 West Fairbanks avenue
al Home lWinter Park, Florida 32789 300 (407) 647 -1942
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
Elaine at Dr.W_aldheim's Office was contacted on 8/16/93 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. waldheim will complete
and sign the medical certification of cause of death.
was contacted on . He /she verified that
, Medical Examiner, will complete and sign the
medical certification.
6. Place of In state cemetery/ Orange County Crematory Removal r��1
Final Disposition: Cremation ( crematory - name /county: Orange County n from state I I Donation
7. Funeral Director/ Signature F.E. No. /Reg. No. Date Signed
Direct Disposer August 16, 1993
B BURIAL — TRANSIT PERMIT 300 -2467
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 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.
Re istrar or Date Date Certifi t
9j_ `� 8Y��/93
S e i rar tgna ur - Issued: 8/16/93 Due:
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature , Medical Examiner Date
or ,(
Medical Examiner, -T ;^ M4 b.A.i) Al C-- �'�� - , gave authorization by telephone to i� 4. �+ —
Funeral Director /Direct Disposer. Date "1Y�
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 JZAit �
❑ BURIAL ❑ STORAGE Date of Disposition Niggst 20,1993
CREMATION ❑ OTHER (Specify) Tag # 2741
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)
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