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HomeMy WebLinkAbout2-40-03I� I� - _ __ __ �h, w�. c„„ +�, �( w a�,w.� ..i �r �/ � � � ��,i '" ��� x� � � t . ,,;, `� �. �.' �-�---._.._:.i�: � �' � �� s N �' e � �' - �° � . �� .., � � , , � , _. _ '}_ _ -- ---�, _ --- --- }, £ .� � �v�-�� ,, -�� � � � � �G�'� � ti � � -�a� < � . �'� � • _. �' ��� ,��\ �, �► � � � �� ,��� � - - , - --_____..�s_ . . �i �� . :�# . _ �! 5� -�,�� �. _-�;;""� , � :_ :�,• _ —_ �, �� , �� :� _ � ��� � �° ` � lc�`,�''°, !.: '� )� � � �� / . � � .�{ � �, Y ,�rti --- � i F.R$ ` , - . l�. ,,.�._ �,, �a1 ��.J;��J ��_. _ �� ��� i ,� . � �w- � : ��� . �� t � � -�o � ��,. . � �,_ _ � � � � _ ��_ �;�� �; .� �.�� �� � � ��. �' � _: ; �«d :�����``, � ���� ��Ch�rles � �� � �. � � '' ��� Z:II�i� Mr�.� �Charles (�7.3.�abeth) ��� � � � * �, � UNIT 2, Block L�O, Lots 2, 3 �' ..... .— < �s `�� a � -�,���°� ' �^-�- � �� � .; � c,�,�-� � , g � z � r� � � � � � � �� � z �� { � ' (. � F �.. �- ' i:,`. , . .. .. .. � �� . .... . . . .... . . ..e., .. .. . .. . ... .. . ....-� . ,i� .. .. .."_ . .. .�_ .. . ... .. .. . . � . � - . . . . (Changing lots �,40 in Blk. 30,'Unit 1 for these) Deed #118 8/5/68 (Replaces Deed #91) Pa3d by General ReceIpt rTo . .............. . Dated..:........................... (100.00) 2 Charles S. Zimmsr I.dst Pr3ce # .................. Maximum No. Burial epaces ............ 550 Futch Ulay. ';� Discount $ .................. Total area in sqnare txt ................ Sebastian, Fla. 32958 Net Paid $ • • . . . . . . . . . . . . . . . . llionument permitted . . . . . . . . . . . . . . . . . . Un 1 t ,�' � " � (Data above ii�ie line for C$ty Record only) B1�c. 40� LO�S 2& 3 i Name � � _' a; ! � w' ,: � Unit L.� �� � � Block Lot E�f� ,. �, '��, �%. �`: �,F•� Date of Mark-out �, { � . Z„ �,, �;�, `��' " Time ���� • r � � Date of Burial x ^� �".�=—� ��, ,� � �,� tfi." b'�`��" ,t �� a'" r Name of Funeral Home � ^� Auth�rized by ��' � � ,' _ J__ �-I ���� x ,.{�, . , ,�, , � ...:, _ ;' ��t��( ��''; � ` ��, Chstrl� s , `� ZI1NM�i� Mr�. Charl.es (�13.�abeth) �, UNIT 2, Block LtO, Lots 2, 3 . ., .... ,-- �� � � � � � � ���.:�8� � � � � � ������ � � � c���� r �" g / � � %� � �' � � � i ___ (Changing lots �,40 in Blk: 30,`Unit 1 For these) Paid by Generai Receipt No . .............. . Dated..:....... 8�5�68:.......... List Price $....�100•���... 114aaimum No. Burial spaces ....?....... Discount $ .................. Total area in eqnare feet ................ Net Paid $ .................. Monument pesmitted .............. .... (Bata above titie line for f�ty Itecord only) Deed #118 (Replaces Deed #91) Charles S. Zimmer 550 Futch UJay.z `� Sebastian, Fla�. 32958 Un i t ,�.�; �►� Blk. 40, Lo�ts 2& 3 �� � STATE qF FLORIDA DEPARTME�VT QF HEALTH & REHABILITATIVE SERVICES �-` t �' VITALSTATISTICS- �- APPLICATION FOR BURIAL—TRANSIT PERMIT ; , �,a. � �� � � , .. � � � t �,. , . ...'��r � � a, 3 � �� -- --�-� .� ---- - - A. (Type or Print) 1. Name of First Middle Last '` DATE Month : Day Year Deceased CHARLES � S.' ": ':. °""' '`; ` ZIMMER OEATH AUGUS� 22, 1987 2. Place of Death City, Town or Location �� •'< �'' '• `�Name of '(If neither, give street addressl County , . , j , . , �.. , , _,a , :. ,� �z :i�:.?:.,,Hosp .or - INDIAN RIVER ROSELAND -��5� HUMANA HOSPITAL—SEBASTIAM 3. Name of Medical �Physician 937 BAREFOOT BLVD.Address Certifier MUHAMMAD, M.D. ,,- ,:� ,v�, i..;, ❑ Medical Examine.r, •: SEBASTIAN, FLORIDA $►89-4349 4. Funeral Home/ . . Name' :, k, ; , : ,.; � . ':� ' t, e. ., ; i ,.� ;. �Address ; ��er STRUNK FIINERAL� AOME 'F:` :1623 �NORTH 'CENTRAL''AVENUE ° ` SEBASTIAN, FLORIDA;: — -- - , 5. Check a.[] , The me4�i,CaI,Cglti�����ion 1��s beer� Compl��d �nd �gned. Acomp�eted certificate pf de�th accompanies Appra ���5 #PQ�;4Cdt��• < ^ 1 , �, ., ,:�. ,, � ' priate b� , ' DR. SIDDIQUI � was contacted o��Z_. He/Ishe verified that 8ox this death was from natural causes,<that, there was no accident nor other external cause oF death, and that � will complete and sign the medica� certification of cause of death. ' �i ,..ar��� ...�q, _ .�a�M±' >ptN1.w1M!-�!�F�w�; kM. W�+Mn.�,,.t?k�v f�.ic�a,il�r . �: . . . . , - - � c Q ' ��was contacted on . He�she verified that ` �' '` - �'' ` { • ' ' ' ` ' , Medical Examiner, will complete and sign the medical certificatio�. 6. Funeral Director/ 7�K�Xt���r Signature;�: a. T°',.' � f. Fla. Lic. No./Reg. No. � � A 2088 �ate Signed 8/�4/87 B. BURIAL-TRANSIT PERMIT Permit No. �28-8�-313 Permission is hereby granted to dispose of this hady �. ���� ���� � �A five day e te►►►§i.on f tjm¢ for filin e F��,th��rtificat��(exclusive af weekends) has be¢n requested and . � n. Q 9, �� ,.4�� „ „ granted. If it.cannot be f�led within t is t��e limit, a Funeral Director/Direct Disposer Rep�ort will be filed with the �.ocal Reai;tra� of ��e Go�j�t in,v)rt)ic�,cl�,ath ciccurre�l. �'`s'���1�„ w.:.� :, ,j a :.i..',���,•wt.i `z.,�.w •:. Registrar or � Date 8�24�8� . Sub-Registrar Signatu Issued ; , ....._ . .. , . ......:. ......_,_ w,,...,. � C. AUTHORIZATION for CREMATION;'DISSECTION or BURIAL—AT—SEA .. ,`;,,. q , � ._-• r .,,,:: � . Signature ' ' ' "' ��"�`' ;�"' ''; Med'icel Ezaminer ' Date or . Medical Examiner, '`'`�`�'` ' "' ' ��`'' ' � � ;'gave'authoriiation by telephone to Funeral Director/Direct Disposer. Date The Medical Exemine� s approval must be obtained befo�e"disposal�b'y any of the above methods. A waiting period of 48 t�ours after death . is required for all cremations. � � J�a- Rf��l ( ���, •� � , ! • t ' Y J�i.tm` Ji ��.. 4 �.. `i. r z . ., ...i . . � D. . . . . ,.. } . CEMFz���� Q13. ���MAT4RY . } r 1 . Y Gt i'��.I. f;. Method of Disposition: � BURIAL � STORAGE � CREMATION � OTHER (Specify) � Signature of Sexton or Perso�-in-Charge Place of Disposition E Date of Disposition � This permit must be endorsed by the Sexton or persoNin-char� (or by th�Funeral Director/Direct Disposer when tlhere is no Sexton) and returned within 10 days to the local County Health Department in the County where disposition occurred. i I