HomeMy WebLinkAbout2-45-14a 0 U,
0 Q
Lou
...........
.
. . ... ......
O.
0 Q
Block 45 LOT 13 &14
UNIT 2 addn,
J�so,✓
Pl
no-
CEMETERY
Paid by AMrVRecelpt No. ..3 01 .... .... Dated.. 4-2.7-- 82 ................
List Price 56..3QO...QA..... Maximum No. Burial spaces .2..........
Discount $......0.......... Total area in square feet
Net Paid $ . , 3 0 0 .. 0 0 ..... Monument permitted . F-1.411: .............
R & R ISSUED WITH DEED (Data above this line for City Record only)
DEED # 491
ERNA CURTISS AND /OR
JASON CURTISS
P. O. BOX 152
roseland, florida 32957
UNIT 2add.,BLK.45,LOT 13&14
State of Florida, Departmq if Health and Rehabilitative Services, Vital tics 46 �/6
APPLICATI FOR BURIAL — TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Diay Year
Deceased C„na Curti s DEOATH 12/13/95
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst.7980 129th Street
3. Name of Medical
Medical Examiner
Address Phone Number
Certifier
13230 U.S.
Highway #1
David DePutrcn,
D.O.
X7 Physician Sebastian
Florida 32958 (407)589-6888
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 AD
Rnrhara
was contacted on �z2,! 14,i;LS 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 David DePut
ron . D.O. 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 ofSebastian Cemetery in cemetery / Removal
Final Disposition: matory - / ounty: Indian River from state Donation
7. Funeral Director/ gnature F.E. No. /Reg. No. Date Signed
DiMeet-BiSpesgr:..
B BURIAL — TRANSIT PERMIT 1228 25 -0543
Permit No.
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 the death certificate requested.
Re@00pa ►or Date Date Certificate ,
Subregistrar Signature L Issued: I Z it 3 I ts 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 468 hours after
death is required for all cremations.
D. CEMETERY OR CREMATORY
Methods of Disposition: Place of Disposition a eb ° s t u n C e t o r-y-_
(BURIAL ❑ STORAGE Date of Disposition nPjr- PmhP_r 1 9, 1 0195
❑ 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 its 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)