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CEMETERY DEED # 479
Paid by CrXXOX Receipt No. .293 ....... .... Dated. .Jannazy..4., . j982• • • • • . UNIT 2 ADDN, BLK. 44, LOT 13 & 14
List Price $... $200.00 Maximum No. Busial aces .....�.. .
aP . EUGENE & PATRICIA EWERT
Discount $.... - 0- ........ Total area in 8' ' quare legit * * * * * ** *409 S. W. Pine Street
Net Paid $...$200.00..... Monument permitted , . , F1at .Sebastian,. Florida 32958
R. & R Issued with deed (Data above this line for tatty Record only)
UNIT 2 ADDN. BLOCK 44 -LOTS 13 & 14
EUGENE EWERT AND OR DEED # 479
PATRICIA EWERT
409 S. W. Pine Street
Sebastian, Florida 32958
george Ewert Interred 6,118183 In Lot #13
STATE OF FLORIDA
DEPARTMENT OF HEALTH & REHABILIT E SERVICES
VITAL STATISTICS �/y
IN.I n" I MEAT q- 111.11 111 .�M)
APPLICATION FOR BURIAL— TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
MARIE EWERT DEATH MAY 25, 1988
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
INDIAN RIVER VERO BEACH Inst. INDIAN RIVER MEMORIAL HOSPITAL
3. Name of Medical Physician Address Phone Number
Certifier BRODUS SOWELL, M.D. p Medical Examiner 2300 -5TH AVENUE VERO BEACH, FL 567 -7111
4. Funeral Home/ Name Address Phone Number (Area Code)
Direct Disposer STRUNK FUNERAL HOME 1623 N. CENTRAL AVENUE SEBASTIAN, FL 407 -589+ -1000
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate LISA
Box b was contacted on 5/26/8$
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 DR. BROADUS SOWELL, M.D. will complete
and sign the medical certification of cause of death.
C ❑ was contacted on . He /she verified that
medical certification. Medical Examiner, will complete and sign the
6. Funeral Director/ Signature Fla. Lic. No. /Reg. No. Date Signed
Direct- fjis�eae�. /%J
#1672 5126/88
B. BURIAL— TRANSIT PERMIT
Per No. 128 -88 -255
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 Coun t y in which death occurred.
❑ No extension of time for filing death certificate er queste .
Registrar or Date 5/26/88 Date Certificate
Subregistrar Signature Issued: Due:
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature , Medical Examiner Date
or
Medical Examiner, , gave authorization by telephone to
Funeral Director /Direct Disooser. 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
Metho f Disposition: Place of Disposition j -
BUR IAL ❑ STORAGE
Date of Disposition
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge ) /I ,O� D
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 County Health Department in the County where disposition occurred.
HRS Form 326, Oct 87 (Replaces May 86edition which may be used)
(Stock Number: 5740 - 000 - 0326 -2)