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BLOCK 46 LOTS 7 & 8 UNIT 2 Addition DEED #404 J
Mr. and Mrs. George Haug
Roseland Road �j L� -�o� P
P. 0. Box 31
Roseland, Fl
DEED #404
George J. Haug
Paid by General Receipt No. ?82..... .... Dated4/.U/00 .............. Roseland Road
P. O. Box 31
List Price 01 20D.DOA :t.... Maximum No. Burial spaces ... ....... Roseland,, FI
Discount $ ................ Total area in square. feet ................
Net Paid $.. *. *.2.Q0..Q.Q *. *. Monument permitted ... Flat... ..... Blk 46 Lots 7 & 8 Unit ;
(Data above this line for City Record only)
R &R Attached
STATE OF FLORIDA
PARTMENT OF HEALTH AND REHABILITATERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL- TRANSIT PERMIT
NAME OF First
Middle
Last
DATE Month Day Year
D
(Type or prriint) GEORGE
J.
HAUG
IDEATH
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME OF (if not in hospital, give street address)
HOSPITAL OR
COUNTY Indian River
Roseland
INSTITUTIONSeb Stian River
Attending Physician XX
(Name of Medical Certifier)
(Address)
Medical Examiners ❑ Muhammad
Faroo , MD,
Washington Plaza
Sebastian Florida 32958
Funeral (Name)
(Address)
Home Cox- Gifford - Baldwin Funeral
Home 1950 20th Street Vero Beach Florida 3
Check A ❑ A completed certificate of death accompanies this application.
One
Funeral
Directo
B ® Dr. Muhammad Ear000 was contacted on Nov. 19 — 119213
He has assured me that this death was from natural causes and that he will complete and sign the medical
certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medical Examiners jurisdiction.
The body was released to me by
on ,19
UAIf�TiafHM t e
Permit
BURIAL TRANSIT PERMIT
No. 5- 264 -1980
Permission is hereby granted to dispose of this body by burial, transportation out of state, storage or cremation. For cremation a
waiting period of 48 hours after death must be observed and the Medical Examiner's approval must also be obtained.
Q A five day extension of time for filing the death certificate has been requested and granted.
Signature of
Method of D sition
isp 7URIAL
❑ CREMATION
❑ STORAGE
❑ OTHER(Specify)
Date
CEMETERY OR CREMATORY
Date
Disposition
Signature of Sexton
or Person in Charge
This permit must endo ed b the sexton or pe son
within 10 days to the local county health department.
HRS Form 326 (1/77)
Place of
Disposition
funeral director when there is no sexton) and returned
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