HomeMy WebLinkAbout2-45-06/�.�� � S
MUZECK, RAYAOND & EMEL Block 45, Lots 5,6,7,8
12965 74Th Terrace Unit #2 Addn't
Sebastian, Florida 32958 (Roseland) Deed #463
Receipt # 268
Block #45, Lots 5 6, 7, 8
Frank Muzechenko - Interred 9 -8 -81 - Lot #8
on
Name A V Cr 10r,: l {"� i{ kA i t C_ K
Unit
Block 44 hf
Lot
z
Date of Mark -out 6, /rc I/ -�—
Date of Burial ` Lj /hA - Time
Name of Funeral Home SrR a '6
Auth
O-t,mvtzq DEED #463
Paid by IMMMM& R ceipt No. ...268 7122181 Unit #267,8, dn. Block 45
Dated...
...... Lots, 5
List Price $, , , , 400.00 ;Maximum No. Burial spaces ... 4.. RAYMOND MUZECK (Husband)
0 ETHEL MUZECK (WIFE)
Discount $ .................. Total area in square tat . *. * *, * *, * * **
Net Paid 8.. 400.00 Flat 12965 74th Terrace
Monument permitted .. Flat ........... Sebastian, Florida 32958
kv /i�rJ�7b (Data above this line for City Record only) (Roseland)
QState of Florida, Departm Health and Rehabilitative Services, Vital tics
APPLICAT FOR BURIAL — TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased Raymond Muzeck DEATH 06/15/1992
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst. Humana HAani+Al- Schwa +ian
3. Name of
Certifier
Medical Examiner Address
937 Barefoot Blvd.
Number
.� I... u . Al . , _ _._.. uaa c i v Li
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, F1 32 58 122R (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 M2riQ;a was contacted on nc X16 /, "2iithin 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 Muhammarl Siddi c}tti, MIL 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 Sebastian Cemetery tate cemetery/ Removal
Final Disposition: crematory - name/ nty: Indian ve from state Donation
7. Funeral Director/ tore F.E. No. /Reg -Nur-� Date Signed
QWeCtt'�M 03ff t 090 nc II a /1 nnn
B. BURIAL — TRANSIT PERMIT
Permit No. 1228 -92 -0299
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 file ith the Local Registrar of the County in which death occurred.
C3 No extension of time for fill t e death certificate requeste
Registrar or _ Date ,�i Date Certificate
Subregistrar Signature Issued: - / Due:
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
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.
D. CEMETERY OR CREMATORY
Methods of Disposition:
! BURIAL
❑ CREMATION
Signature of Sexton )
or Person -in- Charge )
❑ STORAGE
❑ OTHER (Specify)
Place of Disposition
Date of Disposition /���-
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)