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Home My WebLink About2-05-03Paid by General Receipt No. 130 List Price Discount Net Paid 350.00 350.00 Dated.. March .12.,..13 Maximum No. Burial spaces Total area in square feet Monument permitted Flat 2 (Data above this line for City Record only) DEED #350 Mrs. Dorothy Bishop 101 Edward Drive Whispering Palms Mobile V. Sebastian Lots 3 4, Bik 5, U Mary Lou Irby Mary Lou Irby died Sept. 9, 2009, at her daughter's home in Largo. She was born in Kankakee, III., and lived in Largo, coming from Vero Beach. Survivors include her daughters, Barbara Amaral, Michele Sporck and Cindie Powledge; son, Luke Powledge; sisters, Patricia Wolff and Lois Myers; brother, Merle Bishop; and seven grandchildren. Services: A memorial service will be at noon Sept. 19 at St. Helen Catholic Church, Vero Beach, followed by a small reception. Published in the TC Palm on 9/18/2009 1. Name of First Middle Last Deceased MARY LOU IRBY Date Month Day Year of SEPTEMBER 9, 2009 Death 2. Place of Death City, Town or Location County PINELLAS LARGO Name of (If neither, give street address) Hosp. or 102 MELODY LANE Inst. 3. Name of Medical KIRTI PATEL, M.D. Certifier Address 1258 WEST BAY DRIVE LARGO, FLORIDA 33770 Phone Number (727) 585 -5431 rlMedical Examiner ]Physician 4. Name of Funeral Home /Direct Disposal Establishment NATIONAL CREMATION SOCIETY Address 4945 EAST BAY DRIVE CLEARWATER, FLORIDA 33764 Fla. Lic. No. /Reg. No. F040341 Phone No. (Area Code) (727)536 -0494 A. 5. Check Appropriate Box 6. Funeral Director/ Direct Disposer B. C. D. Approval Number: (TYPE) Method of Disposition: 0BURIAL CREMATION Signature of Sexton or Person -in- Charge a. b. E c. medi THOR DH 326, 8/97 (Obsoletes all previous editions) (Stock Number: 5740 000 0326 -2) u 6 -5 L 3 State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL TRANSIT PERMIT C OP( The medical certification has been completed and signed. A completed certificate of death accompanies this application. SHANNON DR. PATEL S OFFICE was contacted on 09/09/2009 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that KIRTI PATEL, M.D. will complete and sign the medical certification of cause of death within 72 hours. ion of cause of death within 72 hours. was contacted on AL TRANSIT PERMIT No./Reg. No. He /she verified that Medical Examiner, will complete and sign the Date Signed 09/09/2009 Permission is hereby granted to ispo e of this body. Permit No.09- 40341 -664 A five (5) day extension of time for filing the death ificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. 0No extension of time for filing the death certificate has been requested. Registrar or Date Date Certificate Subregistrar Si: ature Issued: 09/09/2009 TION for CREMATION, DISSECTION, or BURIAL -AT -SEA Date STORAGE Date of Disposition DOTHER (Sp fy) Dye:. 09/21/2009 Medical Examiner, gave authorization by telephone to V 6 PFX Funeral Director /Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting perio of 48 ours after death is required for all cremations. CEMETERY OR CREMATORY Place of Disposition SQ get37PF.✓ L'/��or/ '('('1 SEP 1 2009 This permit must be endorsed by t xton 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 -h Department in.the county where disposition occurred. Distribution: White: Cemetery or Crematory Yellow. Funeral Director or Direct Disposer Pink: Local Registrar R.esY Rs M. Sep 26 2008 2:4SPM FUNERAL HOME: ADDRESS: PHONE FUNERAL DIRECT R'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEBArtgN WW1 G Pluo.kituwo For informatior. contact: Kt i Kelso Cemetery Sexton Ser estian Municipal Cemetery (772) 589 -2545 City Clerk's Office try Hall, 1225 Main Street Sebastian, FL 32958 Oltic (772) 388.8215 or 388 -8214 Fax: (772) 589.5570 L'% ,1. ►or 1 23 No. Central Ave. (Check One) OPEN BURIAL LOT L l 3 Block Unit OPEN CREMAINS LOT L t Block Unit OPEN COLUMBARIUM NICHE the Block BURIAL DATE AND SERVICE TIME: FOR DECEASED: 4/4 'vane HP LASERJET 3200 NAME AND.SIGNATi1RE OF LOT OW ER OR EPRESEVTATIVE: (Mus ovide or r yFp umentation of wners Name Name Cemetery Sexton Certification: 1 certify that I have checked the owners with Clerk's office and that all fees have Cemetery Sexton Signature Date Date I certify that I have determined the owne ship of the above described site that all site fees and administrative fees have been paid and uthorize opening of same NAME AND SIGDIATJRE OF LICENSE FUNE Date ip information by viewing the owner's deed and confirming b een paid This founto be provided to Clerk's Off.c by Sexton for perrnanert record upon compietion. p. 1 Name M Unit Block 7J Lot Date of Mark -out 9/. /0 9 Date of Burial rbl/e? Name of Funeral Home 5 u rl i Authorized by Date No. 001501343805 Cemetery Fees RECEIPT 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501 341910 LDCICode of Ordinances 001501 341930 Election Qualifying Fees V II ��f 601010 343800 Cemetery Lots Lot/Niche Block 5 Unit krtWis White Dept of Origin Yellow Finance Pink Applicant Loa, 7p/3 Total Paid 4545 o Cash Check# t l Amount Paid 5 CO Time r .0..P sue=° �cr� F