HomeMy WebLinkAbout2-45-07�- _� ____.___�L„
%�.�� � �`
U
z
Paid by C �–
lftuftiii- Receipt No. 268 DEED #463
....... Dated... . 7122181
List Price $ �ji�q . pj�. .......................... Unit #2 Addn., -810Ck 45
Discount $ – 0 214aximurn No. B Lots, 5,607,,8,
.... ............ Burial spaces ..... :�AYMOIVD MUZECK
Net Paid $ .... �qoxo Total, area in square feet .1 *********ETHEL MUZWCK (WIFE)
..............
Monument Permitted ,Flat.... . . '12965 7
.......... -4th Terrace
(Data above this line for City Sebastian, Florida 32958
.v Re— cord only) (Roseland
)
C)
\J\�
0 0 U
Ln
X
f4:.
U
Paid by C �–
lftuftiii- Receipt No. 268 DEED #463
....... Dated... . 7122181
List Price $ �ji�q . pj�. .......................... Unit #2 Addn., -810Ck 45
Discount $ – 0 214aximurn No. B Lots, 5,607,,8,
.... ............ Burial spaces ..... :�AYMOIVD MUZECK
Net Paid $ .... �qoxo Total, area in square feet .1 *********ETHEL MUZWCK (WIFE)
..............
Monument Permitted ,Flat.... . . '12965 7
.......... -4th Terrace
(Data above this line for City Sebastian, Florida 32958
.v Re— cord only) (Roseland
)
J
BLOCK 45
LOTS 5,6,7,8 UNIT #2 Addn't.
Deed #463
Mr. & Mrs. Raymond & Ethel Muzeck
12965 74th Terrace
Sebastian, Florida 32958 (Roseland)
Frank Muzechenko - Interred 9 -8 -81 - Lot #8
&41L It Tn ferrz-CL /- 7 -93-. Lct 7
OPARTMENT OF HESTATE OF FLORIDA
ALTH & REHABIILITOE SERVICES J u c`l
VITAL STATISTICS
APPLICATION FOR BURIAL - TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased Martha Muzeahenko DEATH Jan. 4, 1985
2. Place of Death City, Town or Location Name of (if neither, give street address)
County Hosp. or
Brevard Melbourne Inst. Carnegie Gardens
3. Name of Medical RkPhysician Address
Certifier Mohammad Idrees, M.D. ❑ Medical Examiner 112 Bellaire Lane Palm Bay, Florida 32905
4. Funeral Home/ Name Address
>+>rxfx Pottinger & Son Funeral Home 1200 S. Indian River Drive Sebastian Florida 32958
6. Check a * The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate b ❑ was contacted on . He /she verified that
Box this death was from natural causes, that there was no accident nor other external cause of death, and that
6.
r]
C
Q
will complete and sign the medical certification of
cause of death.
C ❑ was contacted on . He /she verified that
r'1 . A Medical Examiner, will complete and sign the
certif
al Director/
Fla. Lic.
BURIAL - TRANSIT PERMIT
Rag. No.
Permit No..- _ - r?
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 within this time limit, a "Funeral Director / Direct Dispow Report" will 40 filo
with the Local Registrar of the County in which death occurred.
Registrar or tf- Date
���
Sub- Registrar Signature �ecj0WU J' i �,�,Issued
Signature
or
AUTHORIZATION for CREMATION, DISSECTION or BURIAL -AT
, Medical Examiner Date
Medical Examiner, , gave authorization by telephone to
Funeral Director /Direct Disposer. Data
The Medical Examiner's approval must be obtained before disposal by any of the above me%hods. A waiting period of 48 hours after death
is required for all cremations.
Y
Method of Disposition:
BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton
or Person -in- Charge
Axod e.
CEMETERY OR CREMATOR
r
Place of Disposition Sebastian Cemetery
Date of Disposition January 7, 1985
DEBORAH C. RAG S, CITY CLERK
the Funeral Director /Direct Disposer when there is no Sexton)
i County where disposition omurrod.
This permit must be endorsed by the Sexton or person -in- charge (or
and returned within 10 days to the local County Health Department iiI
HRS Form 326, APR. 81
(replaces previous editions which may be used.)