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DORIS VIRGINIA GLOYD
Doris Virginia Gloyd 81, Lake Worth, FL, passed away Saturday,
September 22, 2012 at her residence. Doris was born on September
5, 1931 in Moultrie, Georgia. She was a member of Sebastian River
Baptist Church.
Doris is survived by; Daughters, Becky Clifton of Lake Worth, FL,
Deborah Ellis of West Palm Beach, FL, Sons, Larry Jack Carter of
Melbourne, FL, Gregory Robbin Carter of Perry, FL, Sister, Tiney
White of Sebastian, FL, Brothers, Bobby Hiers of Sebastian, FL,
Dennis Hiers of Melbourne, FL, Lloyd Hiers of Valkeria, FL, and Leroy
Hiers of Fellsmere, FL. 11 Granddaughters and 20 Great
Grandchildren.
- -ti
ELC1RtD?�DFI'A6[[6iE�iAF•. ;' State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: September 26, 2012 TRACKING NUMBER: 2012130042
1. DECEDENT INFORMATION
Name of Deceased Date of Death
DORIS VIRGINIA GLOYD September 22, 2012
Place of Death - County City, Town or Lxatlon Name of facility, or street address 'rf not a facllity
PALM BEACH LAKE WORTH 13 PIANTATION BLVD
Name and Address of Funeral Nome/Direct Disposal Establishment Fla. Lic. No.lReg. No. Phone Num6er
SEAWINDS FUNERAL HOME & CREMATORY F041682 F041682 (772) 589-1933
735 SOUTH FLEMING STREET
SEBASTIAN, FLORIDA, 32958
Funeral Director/Direct Disposer Fla. Lic. No./Reg. No.
ANTHONY GABBARD F044749
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2o12-F041682-5092
� aG % �� • Date Issued: September 24, 2012
�. J.�
Meade Grigg, State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: SEBASTIAN CEMETERY
Method of Disposition: BuRtA� Date of Disposition: � 2�i /'L '
Signatu of xton or person-in� rge (or by the funeral director/direct disposer when there is no seuton}
DH 326E, 1/11
64V-1.011, Fbrida Administrative Code
FUNERAL DIRECTOR'5 REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEME7ERY
�tAN
ItOME 6'� vtuc�H isuno �
For information conlact:
Kip Kelso - Cemetery Sexton
SeUastian Municipa! Gemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebascian, FL 32958
Olfice (772) 388-82i5 or 388-8214
F�x: {772) 589-557U
FUNERAL HOME: 5 `',�f �,,,r ,� S
ADDRESS:
PHONE #: f �7,�2 � 5"'8�- /��3�
(Check One)
_� OPEN BURIAL LOT l.ot !( � Block �Unit �_
�PEN CREMAINS LOT Lot __�Block Unit
_SJPEN COLUMBARIUM NICHE Nich� Biock Unit
� W
BURIA� DATE AND SERVICE TIME: ����,�i '°a —
. � ��� e�J
FOR DECEASED: o
ivame
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE'
(Musl provide proper documentatior� of ownership)
� I.,/.�z� � � /�
Name Signature Date
i certify that i have determined the ownership of the above described site that all site fees and
administrative fees have been paid and authorize opernr�g of same
NA��1E AND SIGNATURE OF LICENSED FUNERAL DIREC-TC�R.
/1� l� •
rvame Signature Date
Cemetery Sexton Certification:
I certify thal I have checked the ownership infor�t��at�on by viewing the owner's deed and coniirming
with Clerk's office .�nd th�t all fees have been pa�d
__�! /�(o /�.
Cem tery xton Daie
This forrT� to be provided to Clerk's Office by Sexton for permanent record upon complet�on.
Paid b �/ - .
Y General Recelpt No. . `, %� . . . .
.... nat�a.. .G. -a2.� - �,�-
List i'rice � ' .... ........
$.... c�.�..s� .
Discount '—""�---�- Maximum N,� gu j� ��� �
S•. .......
Nrt Paid a. . . . �as °�' Total area ia sqnan tat . . ,`%G. . . . .
... .... Moaument penaitted ....`���Gd,!��
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