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Home My WebLink About2-34-03O F W W x h W H 5 f U C U � C � c� ti N Q W i, ti a F Q W U w s a orn Name— livEbb, /E /, # Unit Block-3-//---- Lot Date of Mark-out !V / �'a (p/.2 C) Time 44- Date of Burial Name of Funeral/Home Authorized by Gilbert B. (Interred) UNIT 2, Block 342 Lots 31 4 Indian River Vero Beach 1 1000 36th Street, Vero 3. Name of Medical Medical Examiner Doctors ClinicAddress Phone Number Certifier i 3850 20th Street Donald J. Morris, M.D. X Physician Vero Beach Fl. 32960 561-567- ill 4. Name of Funeral Home / Address Fla. L ic. No. /Reg. No. Phone Number (Area Code) Direct Disposer 916 17th Street Strunk Funeral Home Vero Beach, Fl. 32960 0130 561 -562 -2325 5. Check Appro- priate Box a ❑ The medical certification has been this application. and signed. A completed certificate of death accompanies b 13 Tammy was contacted on 6/17.97 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 Dnnn 1 d J_ Mnrri S, M n. will complete and sign the medical, certification of cause of death. c ❑ medical certification. was contacted on . He /she verified that , Medical Examiner, will complete and sign the 6: Place of Sebastian Cemetery In state cemetery/ Removal Final Disposition: r-y]Arematory - name /qwnty: Tn,44.n P4,,n,- n from state n Donation 7. Funeral Director / Z ture F.E. No. /Reg. No. Da e Si d Direct Disposer B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 01 10 -97 -0978 ❑ 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 ,,fkd with the Local Registrar of the County in which death occurred. ❑ No extension of time r filing the Registrar or / Subregistrar Signature Date Date Certificate Issued: G " 7" qq� Due: & .4 j- 7 C. ' AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature or , Medical Examiner Date 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. D. CEMETERY OR CREMATORY Methods of Disposition: Place of Disposition �=1�1 1Z BURIAL ❑ STORAGE Date of Disposition Q% 22o, 199 7 % ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in- Charge) ' 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740- 000 - 0326 -2) FState of Florida, Depa WON t of Health and Rehabilitative Services, Vi t atistics 3L� APP LI FOR BURIAL — TRANSIT PERMIT /i �/ A. (Type or Print) 1. Name of First ,Middle Last DATE Month Day Year Deceased OF Neddie L. Campbell DEATH 6/17/97 2. Place of Death City, Town or Locatio Name of (If neither, give street address) County ; Hosp. or Indian ( Inst. River Memorial Hospital Indian River Vero Beach 1 1000 36th Street, Vero 3. Name of Medical Medical Examiner Doctors ClinicAddress Phone Number Certifier i 3850 20th Street Donald J. Morris, M.D. X Physician Vero Beach Fl. 32960 561-567- ill 4. Name of Funeral Home / Address Fla. L ic. No. /Reg. No. Phone Number (Area Code) Direct Disposer 916 17th Street Strunk Funeral Home Vero Beach, Fl. 32960 0130 561 -562 -2325 5. Check Appro- priate Box a ❑ The medical certification has been this application. and signed. A completed certificate of death accompanies b 13 Tammy was contacted on 6/17.97 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 Dnnn 1 d J_ Mnrri S, M n. will complete and sign the medical, certification of cause of death. c ❑ medical certification. was contacted on . He /she verified that , Medical Examiner, will complete and sign the 6: Place of Sebastian Cemetery In state cemetery/ Removal Final Disposition: r-y]Arematory - name /qwnty: Tn,44.n P4,,n,- n from state n Donation 7. Funeral Director / Z ture F.E. No. /Reg. No. Da e Si d Direct Disposer B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 01 10 -97 -0978 ❑ 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 ,,fkd with the Local Registrar of the County in which death occurred. ❑ No extension of time r filing the Registrar or / Subregistrar Signature Date Date Certificate Issued: G " 7" qq� Due: & .4 j- 7 C. ' AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature or , Medical Examiner Date 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. D. CEMETERY OR CREMATORY Methods of Disposition: Place of Disposition �=1�1 1Z BURIAL ❑ STORAGE Date of Disposition Q% 22o, 199 7 % ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in- Charge) ' 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740- 000 - 0326 -2)