HomeMy WebLinkAbout2-43-05�
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CEMETERY
Patd b DDED # 46Z
Y�Rltl�X� Receipt No. .. 266 .... Dated...Ju1.y. 9...�.�81. .
"""" ........ UNIT #2addn., B1k.43 Lot 3,4,5
List Price $, *$300.00* . . ' . . WIENBRANDT
-0- � Mnxlm�m, IVo. Burial spaces ...�........ . E11a (Mother)
Discount $,,,,,,,,,,,,,,,, � *,��*,�**�,*�,* PERRY, Irene J. (E11a'�s dau
ToYal area in aqaare feet ghte2
Net Paid g, *�300. 00* .... .... ........ PERRY, E1den J. (Son in lawJ
• • • . Monument permitted . F.1cit . :.. .. ...:. .. : . P, O. Box 133
� R ISSUED WITH DEED � (Data above tfila Hne for City Record only) ��305 Lan C.zz�cle-Roseland, F1.)
Sebastian, Florida 32958
UNIT #<2 addition BLOCK #43
Mrs. E1Za Weinbrandt or
Mrs. Irene J. Perry ar
; l�lr. EZden J. Perry
. P• O. Box 133
' '(7503 Lan Circle-Roseland, Fl. )
Sebastian, Florida 32958
, � � �
LOTS # 3, 4, & 5 !
DEED # 461 '
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�. Name— f#� = �,� , �J d..�.) �' �I .� b �
uniti . i� /r� ,(� �i 4�'•, ,
Bipck- `i� •
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Lof ;�
Date of Mark-out _ �� /�� ,,� ;� G�
Date of Burial t/��. � f��C7 Time �� � G3 0, i� .,W�
Name of Funeral Home � �.� r� �`,r,/ �• �
Authorized liy =
I � �
4 3..
�. �^�s� . _
�
A.
1. Name of
Deceased
2. P�....c v� vcau �
County
Indian River
3. Name of Medical
Certifier
Farhat Khawja, M.D.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Ho�e�
5. Check a �
Appro-
priate
Box b �
���
State of Florida, rtment of Health and Rehabilitative Servic�ital Statistics
A�CATION FOR BURIAL — TRANSIT PERMIT
� or Printl
Ella
c ❑
6 Place of SEBASTIAN
Final Disposition: , ,, „
7� Funeral Director/
Direct Disposer /� �
�ity, Iown or Location
8ebastian
Middle
Wienbrandt
� � �
/3 y3 '
C� 02 A i
DATE Month Day Year
�F 11/26/90
DEATH
Name of (If neither, give street address)
Hosp. or
Inst. Husana Hospi tal
Examiner Address
Physician Sebastian �
Address
� P•A• 8ebastian F1n32958Avenu
The medical certification has been completed and sigr
this application:
No./Reg. No.� Phone
_ 1228 � ( 4�
A completed certificate of
Number
(Area Code)
3-2325
accompanies
_ Aat
was contacted on '� within 72
hours after death. He/she verified that this death was from natura� causes, that there w�s no accident
nor other exfernal cause of death, and that ._.Farhat Hhaw ia. M. D
and sign the medical certification of cause of death. will complete
was contacted on . He/slhe verified that
, Medical Examiner, will compleqe and sign the
medical certification.
In state cemetery/ SEBASTIAN, FLORIDA ,Aemoval
crematory me/county: I�IAN RIVER from state
' Donation
/j'' � Sign / F.E. jo./Heg-iVp. Date Signed
�� r
B BURIAL — TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 122$-90-0576
❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as umdue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a"Funeral pirector/Direct
Disposer Report° will be filed with the Locat Registrar of the County in which death occurred
❑ No extension of time for fili he death certificate reques d.
Registrar or Date Date Certificate
Subregistrar Signature Issued: � � pUe.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
Signature
, Medical Examiner Date
or
Medical Examiner, , gave authorization by telephone Co
The Medical Examiner's a Funeral Director/Direct Disposer. Date
pproval must be obtained before disposal by any of the above methods. A waiting period of 4$ hours after
death is required for all cremations.
�� CEMETERY OR CREMATORY
Methods of Disposition:
� BURIAL
❑ CREMATION
Signature of Sexton )
or Person-in-Charge )
❑ STORAGE
❑ OTHER (Specify)
0
�
Place of Disposition
Date of Disposition
SEBASTIAN CEMETERY
NOVEMBER 29, 1990
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 891Replaces Oct 87 edition which may be usedl
�Stock Numbec 5740-000-0326-2)