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STATE OF FLORIDA
�RTMENT OF HEALTH & REHABILITAT�ERVICES
V�TAL STATISTICS
APPLICATION FOR BURIAL—TRANSIT PERNIIT
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A. (Type or Print)
i. Name of First Middle Last DATE Month Day Year
Deceased OF
Elisabeth Zimmer DEATH April 10, 1986
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Insc. Humana Hospital 5ebastian
3. Name of Medical � Physician Address
Certifier Muhammad Siddiqui, M.D• (] Medical Examiner 535 Barefoat Blvd. Sebastian Fla. 32958
4. Funeral Home/ Name Addres
���xPottinger & Son Funeral Home 1200 S. Indian River Dr. �ebastian Florida 32958
5. Check a� The medical certification has been completed and signed. A completed certificate of death dccompanies
Appro- this application, �
priate b� was contacted on . He/she verj�ied that
Box this death was from natural causes, that there was no accident nor other external cause of de�ih, and that
will complete and sign the medical certification of
cause of death.
6. Fune.�al Director/
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c� was contacUed on . Me/�k� v�r��s�,�a�� �.�°="
, Medical Examiner, will complete and sign the
��edical certification.
�" � 2558 Apri:l 11, 1986
Signature
Fla. Lic. No./Reg. No.
BURIAL—TRANSIT PERMIT
Date Signed
Permit No. ��
Permission is hereby yranted to dispose of this hody.
� A five day extension of time for filing tt►e death certificate (exclusive of weekends) has been requested and
granted. If it cannot be filed within this time limit, a"Funeral Director/Direct Disposer Report" Will be filed
with the Local Registrar of the County in which death occurred.
Registrar or
Sub-Registrar Signatu
Signature
or
Medical Examiner,
Date �
Issued �!!���
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
, Medical Examiner Date
, gave authorization by telephone to
Funeral Director/Oirect Disposer. Date
The Medical Examiner's approvat must be obtained before disposal by any of the above methods. A waiting period of 48 hours a te `"'"������
is reyuired for all cremations. '
Method of Disposition:
�BURIAL � STORAGE
� CREMATION � OTHER (Specify)
Signature of Sexton
or Person-in-Charge
CEMETERY OR CREMATORY
Place of Disposition Seb3stian Cemetexy
Date of Disposition Apri.l /� 1986
Deborah C. Kra�es — Citv Clerk
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 �eturned within 10 days to the local County Health Department in the County where disposition occurred.
HRS Form 326, APR. 81
(replaces previous editions which may be used.)
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ate of Burial I/ �t � ` - .. ,
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Name of Funerai Home � � ' : • �
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5 Bl�ek 40 I,�t� 2, 3 Ur�i.t �i
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Ziirmier� Gharle� - 7er.�'u°//F'
Zimm.er� Mrs. Ch�,rles (Elisabeth�
Fizt� Wa3r :
Sebastiiin, Flx.
��l�C��t'�'i"� 1 �Tb2iL�.0 �� lS' ��� �� `�
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(Changing lota 39� in Blk: 30, lJnit l f6r `�hese)
Paid by General Receipt � No. . . . . ly . . . . . . . . : . . . . . . . 8�5�6 8. . . . . . . : . . .
. Dated.
L�tat Price �. . . .� 100. OD �.. . . . Maximnm No. Bnrial epacee . . . .?. . . . . . .
niaco,mt � .................. � Toral area m.eqnure taeti ....... ......
Net Paid $ .................. . Monnmeut permitted ...........:.. ....
• . ! (Dats above t�ie line ior (�ty Record onl�)
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Deed #118
(Replaces Deed #91) .
Charles S. Zimmer
550 Futeh i�ay. '���
Sebastian,� Fla. 32958
Un i t �Y; a`L�
Bltc. 40, Lota 2� 3
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QUIT-CI.wIM DEED � DREW'S FORM R. E. •�oufocfursd and for �als by Th� H. i W. 8. Dr�w Company
Jacksonvill�, Florida
��11S �Ult-�laim �eed, EXe�uted th�s �Y� day of November , A. D. t9 68 , by
CHARLES S. ZIMMER, joined by his wife, ELI�ABETH ZIMMER
f irsf pa.rty, to
CITY OF SEBASTIAN, a municipality
whose postof fice adclress is S2bc�St].1I1 � Florida
second party:
(Wherever used herein the terms "(irat party" and "aecond party" shall include singular and plural, heiro, legal
repreaentatives, and assigna oE individuala, and the successors and assigns of corporations, wherever the context
so admita or nquires. )
��NLQSSeLII� That the said f irst party, f or and in consideration o f the sum of $ 10 . 0 0 .
in hand paid by the said second party, tl�e receipt whereof is hereby aclznowledged, does hereby remise, re-
-- lease �d �ait-cTnim ur�#o ��e said second-party forever, aII the right, title, interest, claim and demand which
t�e said f irst party lias in and to tl�e f ollowing described Iot, piece or parcel of land, situate, Iying and being
in t�e �,'ounty o� Indian River State o}'� Florida , to-wit:
Lots 39 and 40, B1ock 30, Unit l, of Sebastian
Municipal Cemetery as per Plat Number 1 thereof
recorded in Plat Book 2, at page 65, public records
in the office of the Clerk of the Circuit Court
of St. Lucie County, Florida, now lying and being
in Indian River County, Florida.
'�'o �laue and to �lold t�e same toget�,er with all and singular the appurtenances thereunto
belonging or in anywise appertaining, and all the estate, right, title, fnterest, Ifen, equity and cla.im what-
soever of tl�e said first party, either in law or equity, to the only proper use, benefit and 6ehoof of th,e said
second party f orever.
�n,�itn�ss �hereof� The saic� `irst party lias signed and sea[ed these presents the day and year
f trst above written. �
Signed',, sealed a Iiv in pre nce o f:
'�/ • _ � .�
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--------------- �' �--- -•-----------•---•---••---•--------.....-------•-----.._. .---............._..--••-•-•---•-------••-- -... ...------•-• • -- ----•----•--�
Charles S. Zi er
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I HEREBY CERTIFY that on this day, before me, an
STATE OF FLORIDA,
COUNTY OF INDIAN RIVER
officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared
CHARLES S. ZIMMER joined by his wife, ELIZABETH ZIMMER
to me known t0 be the persong described in and who executed the foregoing instrument and tYl@j7 acknowledged
before �ve chat the�r executed the same.
1tiITNESS my hand and official seal in the County and State last aforesaid this '� � day of
NOVHItIbC'Y' �- A. T.�. 196 8. �
.
_- ': ••••••... ......•--••• ................ ...........•••••-•••••-•......•-
_ 1�otary...Pu �l�ic'----
- State of Florida at Large
My Commission Expires:
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