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Home My WebLink About2-40-16�'y,,�-..-,,,,, t'�. _� w o.�._•._ � .. x �� `;, �� ., � � - ry=�:�_ � � `�'1-�..____-----� - � ,� � ;� � �� S N �- , e , � �� - �} .,, ,�� . . , Q � a � �,��, a� ,,, � _, � ---;� --- --�, £ .� , � � � 5�'�- �v�� : . � `� Gn�� , � � � � i � � i�sc,�,r:� � � � � �� . �I�-'$°� ` ) , �� ° � � _ -� � � ��, �,,� � �, �� ' ,;��$ � � a� . ,, � . . . � �� :� . �� ,�,� ; �� '..�` �, . . �_.__._�._ _ � � . � _ �, __ �; - - �' � " � �° �`-''� - � _�� . � _ ti - ��/°- - � � �� ( � �� ` �y _ _ :: ,�. � . �. '.�4�FL , � . .. . . . .. . . . .. \ � . �� R$ �...W__.. ,: — �?;,. , , /al •.1.1•�J �,_u__ �� V . �.. /� . . . __-_ . . . � x 3 . . . " . . :� . . . ..� � . ... ��,,..n�. _.. . �'. .s�o � .. �-. �� . . � . r f Name �� T—. � �-: r% `ir� `t ) t. � X. � C�. +�' i"_. . - _—( , , Unit � { Block � � Lot � r C` _ h' lA l �) f i�i 1.�.+ i i (\ --- �"'1 ! � Date of M ark-out r� � e� �� • Date of Burial �5. i r,� � ,�� Time �� , � Name of Funeral Harhe �-�"'�"� 4 ��' � .�. ,, r �.. � Authorized by �lock 1�0 Lats 15, 16 Unit 2 � �� za��, �l� �. �. , � _ n��d # a �� Lave�y, Hilda Olsvx (,'��c��.� Colonial Fimeral Home Rt. 2, Box 396B (Chamberlairi Dr. - Micco) �ebastian, Fla. � r � �'l I �vo � r`)��e�-r� '7��1�a �j � j5 � e,��'Ai�s • �!� � �, �,i9Uo � �� • ��t�v�e� 2�- Q3 �--� �� -�-..� � �° _ �°�- i� �� ---_ __ _ __ _._. ___ __ _ . �, r ... . '., ,' _ . : :- � .,_....�. . './�:.. ��i. 1._,r^" �. . .. ' - ' . ' . ' �y Check oP Coloniel Funeral H �3 ~Pstd by General Reccipt No. �.� . . ac�a.. .J�ul�c .15a .19.T.4. .... ... p,�' � � �l'qii� . . --- List Prlce �.2.QD�QQ......:. Mnxtmum A'o. Burial spaces .......2... DIscount $ .................. � Total area in. eqnatre leet -....C34..... Net Paid $.2AUr.OA . . . . . . .. Monument permitted . . .�ya� . . . ... . . . . .. (Data above this. Une for Ciq+ Record onlY) RdcR Attwcheri DEED #248 'LaVoy, �erl! T.Sr. and _H�a� Q1.�s�a.l�� Blk 40 Unit 2 l�ots 15 d� ,�6 Chemberlain Dr,'micco I�laiwl.ino Add,�eas�, Route 2, 8ox 396B,Sebast�an �-y -i� Jhe %�ort �t. oC ucie C�rematorc� 7�4 Souti� U.S• i-iigi�vray �7�'I P� St. ��,.. �i�aa �os�.�4�� (s6i) 8�8•4000 �e �ere6y certi f y t�at ti�ese are ti�e cremateci remains of Earl Lavoy �ge 70 T�e remains vriere receiveci f rom Cox Gifford Funeral Home 1950 20th St. Vero Beach, F1. :32960 �ate of cieatl� Jan. 25 , 2003 Co�►+ty Indian River perm�t # 1423-019-03 �ss�ed at Vero Beach Meciica� �xaminer�s �ut�orization 03-19-00056 Cremains �� # 3050 �ate of Cremation Jan. 31, 2003 r� . i i T�� i�F`{ i�, ^ remation Juperv�sed oy �jerving Young �j-• pri�� nerp� �omes �' �orest �i��s ��nera� �ome �oger �yrc±-port St. Lucie �unera� �ome � Cox•Gif forc� �unera� uome ... 3�xttiel �c . �uttingrr FUNERAL DIRECTOR �� f�u1�t�Y�X ��xr�r�� rrE South Indian River Drive �rhustixn, ,�lari�x 32958 Telephono 589•4000 J ��li�/A.�✓ .t�Io.�..�r� �o�� C �'�.c�r�.11 � �� ,�im6ulx:tcc �erbitr G, /�'�� Q�tiQ � \ a�'� � iy� ��' ' �� '� ��'��,---- � �,�,►� t�`�` ° ��`�` ...�-' ,�//L i��9 a. L � voy � p.�lL 9 � �'�'9'y' JLLy i � i9 �� ' —� -� �i�� i��T.� ..�,a�,�,��t�-� -�...._ �� a /3t..,�, 4r� �� / � , ____-- � _ _. _._ _... .� r� s,� r�/�"�' ��- �:.��.r.r ,�ast ,AfCu�ern �I!unerxl �am¢ xnD �ih�pel �SERVING ALL OF INDIAN RIVER AND BREVARD COUNTY� T �„ � I � C(TY OF SEBASTIAN CfTY CLERK'S OFFICE � � 7 (� RECEIPT L U Name l._di/ _s � Cash k� AmowkPaW 001001 208001 Sales Tax 001501322900 , Garage Sales 001501 34192!1 CapieslBid Specs. 001501341910 LDCICode of Ordinances 001501362100 Communiiy Center Rent �� Yacht Club Rent 001501 362150 Non Taxable Rent 001501 34,'i800 Cemetery Lots , 601010 343800 Cemetery Lots LoUNiche , Block , Unit 001501369400 Interment Fee ��'�� (/ �� /� 001501 369400 Weekend Service 680800 220f81 Yacht Club Securiy Deposit 680900 220682 Community Center Securily Deposit 680800 220683 Rnrerview Park Secuny De�wsit �_ � � /� Tobl Pald � "'� Inldals . Whia — O�pt. sl0ripin • ��Ilow — Fimna • Pinli • Appliant ti C � � p � � -�� F1,ORIDA DEPARTMENT OF HEALT A. (TYPE) 1. Name of First Deceased Earl State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT Middle J. 2. Place ot Death City, Town or Location County Indian River Vero Beach 3. Name of Medical �� .r..��,,� ddre Certifier � Medical Examiner Physician 4. Name of Funeral Home/Direct Disposal Address Establishment Cox—Gifford Funeral Home 5 Check Appropriate Box 6. Funeral Directod Direct Disooser a. c. Last Lavoy Jr. _ � �'� 6 �� r Date of ' � Death Month D�y Year 1-25-03 Name of (If neither, give street address) Hosp. or �nst. Indian River Memorial Hospital 2500 S 35th Streeti Phone Numbet' Ft. Pierce, FL 34981 772-464-2409 1950 20th Street Vero Beach, FL 32960 Fla. Lic. No./Reg. No. 1423 No. (Area Code) 772-562-2365 a. � The medical certification has been completed and signed. A completed certificate of death accompanies this application. b. � was contacted on . He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. c. � was contacted on medical certification of cause of death within 72 hours. Signature // ' F.E. No./Reg. No. BURIAL - TRANSIT PERMIT He/she verified that , Medical Examiner, will complete and sign the Date Signed 1-29-03 Permission is hereby granted to dispose of this body. Permit No. 1423-019-03 � A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and wiil not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. �No extension of time for filing the death certif e has been r sted. Registrar or • Date 1-29-03 Date Certificate �_30-03 Subregistrar Signatu ` ��"' �—_Issued: Due: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number. (' 3� n'J' QQ�� Date r'� �/�� Medical Examiner, , gave authorization by telephone to Funeral Director/Direct Disposer. 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. �. CEMETERY OR CREMATORY � �- Method of Disposition: Place of Disposition ,s „� � �BURIAL �STORAGE Date of Disposition _�/� y/ � �REMATION Signature of Sexton 1 or Person-in-Charge j �OTHER (Specify) This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Dii within 10 days to the local County Health Department in the county where disposition occurred. Distribution OH 326, B/97 (Obsoleles all previoua edilions) (Stock Numbec 5740-000-0326-2) Disposer when there is no 5exton) anci re rned White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Lacal Repistrar