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Name
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Unit
Block
Lot_
Date of Mark -out
Date of Buria Time
r
Name of Funeral Home'
Authorized by
Cemetery 271 8 -3 -81
Paid by Gi51X&Z Receipt No . .................. Dated.............. I...............
List Price $......2.00..00 .
Discount $...... .. ........
200.00
Net Paid $ ..................
Maximum No. Burial spaces ......2....
Total area in square feet ......
Monument permitted , F1dt
R & R ISSUED WITH DEED #465 (Data above this line for City Record only)
DEED # 465
UNIT #2 ADDN'T., BLOCK 45
LOTS 9 & 10
LLOYD P. & CONSTANCE BOYD
730 S . W . KROEGEL AVENUE
SEBASTIAN, FLA. 32958
589 -1777
FM_ State of Florida, Department of Health and Rehabilitative Services, Vital Statistics
APPLICATI OR BURIAL — TRANSIT PERMIT 'N j
A. (Type or Print) a a /T
1. Name of First Middle Last DATE Month Day Year
Deceased Constance A. Boyd OF 03/07/92
DEATH
2. Place of Death City, Town or Location Name of (if neither, give street address)
County Hosp. or
Indian River Roseland Inst.Humana Hospital- Sebastian
3. Name of Medical
Medical Examiner
Address Phone Number
Certifier
937 Barefoot
Blvd.
Muhammad Siddi
ui, M.D.
X Physician Barefoot Bay,
F1. 32976 (407)664 -4349
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 32958
1228
(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 ]
ni ana
was contacted on 03/10/92 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 Muhammad
Siddigui, M.D. 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 In state cemetery/ Removal
Final Disposition: c tory - na nty: Indian River from state Donation
7. Funeral Director/ atuxe F.E. No. /Reg. No. Date Signed
aeeHD*xem �.� 1672 03/10/92
B.
BURIAL -- TRANSIT PERMIT
Permit No 1228 -92 -0119
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 death certificate re ueste
Registrar or ` Date 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: Place of Disposition Sebastian C e m e t e r y
U BURIAL ❑ STORAGE Date of Disposition 3/11/92
❑ CREMATION ❑ OTHER (Specify)
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)