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Home My WebLink About1-B-24a V L VNIT 1 , z e a rem, Permission is hereby granted to dispose of this body. Permit No. 1228-90-192 ❑ 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 a death certificate requeste . Registrar or Date Date Certificate Subregistrar Signature Issued: 7/20/90 Due: AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature Medical Examiner Date or Medical Examiner, gave authorization by telephone to Funeral The Medical Examiner's approval must be obtain d before Director/Direct disposal lby any ofet the e aboveemethods. A waiting death is required for all cremations. g period of 48 hours after Methods of Disposition: 13 BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition SEBASTIAN CEMETERY Date of Disposition 7/21/90 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. IRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) hock Number: 5740 - 000 - 0326 -2) State of Florida, Dep nt of Health and Rehabilitative Services, leStatistics 6 APPLICATION FOR BURIAL — TRANSIT PERMIT �J A. (Type or Print) 1. Name of First Deceased Middle Last DATE Month Day Year MARY TUMBLIN TERRY OF DEATH 7/19/90 2. Place of Death County City, Town or Location Name of (If neither, give street address) Hosp. or INDIAN RIVER ROSE. LAND Inst. HUMANA HOSPITAL — SEBASTIAN 3. Name of Medical Certifier Medical Examiner Address Phone Number 777 37TH STREET SUITE C -105 JAMES LARGE, M.D. Physician VERO BEACH, FLORIDA 32960 407- 569 -5094 4. Name of Funeral Home/ Direct Disposer Address Fla. Lic. No. /Reg. No. Phone Number (Area Code) 1623 N. CENTRAL AVENUE STRUNK FUNERAL HOMES /SEBASTIAN SEBASTIAN, FLORIDA 32958 41228 407 -589 -1000 5. Check a ❑ Appro- The medical certification has been completed and signed. A completed certificate of death accompanies this application. priate Box b NURSE was contacted on 7/20190 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. LARGE 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 1I certification. 6. Place of SEBASTIAN Final Disposition: In state cemetery/ SEBASTIAN, FLORIDA Removal R crematory - n me /county: INDIAN RIVER COUNTY from state Donation 7. Funeral Director/ • ig tur F.E. No. /Reg. No. Date Signed Difest--Biapese� . 1 ? r,? 7/20/90 B. RIA TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-90-192 ❑ 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 a death certificate requeste . Registrar or Date Date Certificate Subregistrar Signature Issued: 7/20/90 Due: AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature Medical Examiner Date or Medical Examiner, gave authorization by telephone to Funeral The Medical Examiner's approval must be obtain d before Director/Direct disposal lby any ofet the e aboveemethods. A waiting death is required for all cremations. g period of 48 hours after Methods of Disposition: 13 BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition SEBASTIAN CEMETERY Date of Disposition 7/21/90 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. IRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) hock Number: 5740 - 000 - 0326 -2) Name Unit Block Lot Date of Mark-out Date of Burial Time Name of Funeral Home Lj -tit Authorized by C, • E. Ik IL Ir qx O O gwornp -OpLp -n CT 0 co ❑ Sir S C) O C, ig PR g r, ca M n-!j M ,n ?s Tg I Mary "Dot" Fredell Mary "Dot" Fredell, 67, died Nov. 5, 2009, in Wrens, Ga. She was born in Micco and was a lifelong resident, recently moving to Louisville, Ga., with her daughter. Survivors include daughters, Mary Elaine Bryant and Michelle Patterson Miller, both of Louisville, and Candy Combs and Nichole Fredell, both of Micco; brothers, Gene Tumblin of Palm Bay and Cecil Tumblin of Pace; 12 grandchildren; and one great - granddaughter. She was preceded in death by her husband, J.W. Fredell; and brother, J. B. Tumblin. SERVICES: A memorial service will be at 1:30 p.m. Dec. 4 at the First Baptist Church of Fellsmere, with the Rev. Buddy Johns officiating. Published in the TC Palm on 12/1/2009 / o� 44 � 4bp MuLow 0 City of Sebastian Sebastian Centcten Ph. # 1(772) 589 - 2545 Fax # 1(772)228 9927 Note : This is for informational purposes reguarding Monuments Note: This site plan is for Single Markers. Please retura to Attention Cemetery Sexton Size : Bronze : 24 x 16 Names & Dates City Of sebastian Sebastian Cemetery 1921 North Central Avc. 32958 Trim : 28 x 20 at Sebastian Cemetery . DRY MIX Foundation poured By . date Stone installed By : fountainhead Date: 9/24/10 inset vase HIS : HER: mary D. tumblin D.O.B. D.O.B. 1942 D.O.D. D.O.D. 2009 LEGAL DESCRIPTION: UNIT: I BLOCK: B LOT: 24 SQUARE FEET: APPROVED: K . G. K. CHECKED BY: K. G. K. DATE: 9/24110 BY : FOUNTAINHEAD PARK EXAMPLE OR MONUMENT IN QUESTION: BRONZE 24X16 4" THICK ON