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HomeMy WebLinkAbout2-43-15I--- __ f. '_ r','�'FM-� � 3 � W - ' �+. ,� � � � � % � __. _. _ _ __.. _ _ �___ �-- -'---� . _ :_�. _ _ - '-- _� �_ - - �-.� r . . . . . , .� . _..._ _ _.---.--- -_--.__.. `___._._..___ _ �__ ....__ . --- ... �__ _ .._____. _---_..___________ _ . ._-- -- � %�/� /5 �i � Georgia Depanment of Human Re�our� � � a A` Vital Records Sarvice � PERMIT FOR THE DISPOSiTION OF HUMAN REMAINS Ga��iT tii i��RGQ Name of Oeceased � uate or ueem r�mi ueamr NO � 1. � ' /�`"�/1 / �%1� �( L i �J E �%''�' 1%1 � 2 �// � 3, YES O Piace of Death Ho�pital or Sueet No. OR Interment Gmatery Cfty, Town or Locatlon oi Oeeth OR Interment County of sth OR Interment a. U�.�lr�l� ��,� r,, T� ��d �,' T i1 L- e. /�� /`� �J fi S cr � s. /�1�.<,.1 /U� Name of Certifying Phys' ian, Coroner or Medical Examiner Certitier't Addrea Not U�ed For Di�(nterrtwnt/Raintsrrrwnt) • (N�� Used For Uisinterment/Reintermenl) � • 7.F� ri/• � � %% % /� L � �7 � � �.~ �.. 8!�%/%� J �.�.. (, � /�K��.� C C �5� . Funeral Home Neme and Addrest� . - � • neral Home Lic. No. ; , . . .. • ,;t / v gi, �v C f/�{°ii��J ! ( .W F L. :� . r � r� � /� S� C �� • • 1a Method Of Dispoaitio OR Date of Di�potition u�. Burial O Transpon 7D Storage ❑ Di�lnterment/ Refntermant 11. Cremation ❑ Donation ❑ Other ❑ Relnterment O 12./`/�� . Zl / �� Name and Address of Dispocition OR Rainterment Site Location of Dispo:ition OR Rainterment Sita (County, City or State) f L� /7�. � ' , �T,� ,� _.,, r�� �e,�,� 7��,� ,4 ; vF � `�'� � , A Certificate of Death having been filed or the requirement� of the law: of Georgla having been compliad with, permiasion is hereb�� granted to (check only ONE ) DISPOSE OF O DISINTER/REINTER O this body. 1 nral Vitwl Rwrnrde Raeletrar � ISieneturel Data Sipned � �. ts:-. . ��th.� �- +�-� S�sxton ( erao In C Se — Slgneture) ,� t � � �� � Form 3934 (Rev. 10-82� 16. / /G/�/. 7 � ,�i % , D18POSITION/REINTER ,,::,u . . .. _ . , , /,�i��7�-c'aCJ �'`'��^��1�G�=� � ^ — — �,,,c�Q �.' � ,��?,�: ' _ � _ _ - _ - - - �- s'.-�.� � ���� ; ^ _ _ _ _ -- _ _ _ _ _ � � � � ► 5��� , - ���-� r.. 5�-�q I _ - � .��� %� �r_ _ - ��� �' , �. ,' � ,, . .�.; . , . ,, :. . , � � - ; � $ fi � � t. , N&me, /'r"? M` r Ci�, �• �/� �r �a : - - � , .C� ,9 �? � : - � : � Unit } _� , Block �� f � . .. _ . �fk: � . ,..:. . �dt ' i� � .. . , - - : . _. . . , , ; v, ; ; - ; � Date pf Mar,k out � � Y ! � i Date of Burl�l ��,��"� f Time � 1� i�G! �' �''� : i ' , °, � � `: .�.� ' , � ,' i Naine of F�nergPH 8 ' � � � � �- Authorized b` � : ,`� I ; �� T r x. w �4s.es' � ±`' I . . .. . ,,.. " . �... . , , .� + ^ wf`.w$?. s 5 ' � DEED �440 , . , , �. � �;. � , •: � . _ , , . , ,. : 'Cemete y . ; . , Psid bYJ�A4Y# �eceipt No •( 5.:. Dated �...Marah: 6..Z9R.I� Dav is, Marion ` . -.: ;:. . , . 6686 Paradise Lane L;st Price $.#3�,OQ• Maximum Na. Burial ipaces' .2•: Sebastian,: FL 32958 blscount $. .' . ,0.- . . . : ; : To� ' area in 'eqnare � feet : ..Q.�.. : Net PaId $. .*;�SQ. QO* . , ..: : �. Mo�u�uent , f1at, , . ...' ....... Flusband John deceased 3/6/81 t peas�,lxted .' Block 43 ' Lats 1�4 &.,�5 : . �- , . . : � . . Unit' 2 Addition �' RuZes and Regulations Sent �� '«"� a4OVe this Itne for Qty.Reeord only) � �. . �'� Mar�ton Deed #440 � ��$'`�Paradise Lane Sebastian. FL 32958 -. • , . ,�. r '..� � Block #43, `i'.ots 14 and � 15, �Tnit 2 Addition John Dau�s interred in Lot 3+�,.3/6/81 Pottinger's L " �a,vi3 in�-�'fe���1 %��5i �Ia9�4 / //,ii%u'iDn � �