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---STATE OF FLORIDA
PARTMENT OF HEALTH AND REHABILITAT SERVICES
VITAL STATISTICS
*PLICATION FOR BURIAL -TRA PERMIT
NAME OF First
Middle Last
❑
DATE Month Day N-1 *Year
D YPe oSPDntI Clara
Miller
❑
DEAFi`febrUar 27, 1918
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME OF (If not in hospital, give street address)
HOSPITAL OR
COUNTY
Indian River
Vero Beach
INSTITUTION 835 18th St, Apt. #106
Attending Physician]
(Name of Medical Certifier)
(Address)
Medical Examiners o Dr. Rober-L-
L. Moore 2045 15th Ave. Vero Beach, Florida 32960
Funeral ( Name)
(Address)
Home Floyd/Strunk Funeral
Home 2405 14th Avenue Vero Beach, Florida 32960
Check A ❑ A completed certificate of death accompanies this application.
One
B �, Dr. Moore was contacted on February 27 19 81
He has assured me that this death was from natural causes and that he will complete and sign the medical
certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medical Examiners jurisdiction.
The body was released to me by
on 19
(Signature) (Fla. Lic. No.) (Date Signed)
Funeral
D rm
JW. 2088 March 1, 1981
low ic
BURIAL TRANSIT PERMIT rer"130 -850
Permission is hereby granted to dispose of this body by burial, transportation out of state, storage or cremation. For cremation a
waiting period of 48 hours after death must be observed and the Medical Examiner's approval must also be obtained.
[X A five day extension of time for filing the death certificate has been requested and granted.
Signature of
Method of Disposition
QJC
BURIAL
❑
CREMATION
❑
STORAGE
❑
OTHER(Specify)
Signature of Sexton
or Person in Charge
C,
Date March 1, 1981
Issue�f
CEMETERY OR CREMATORY
Date of
Disposition March 2, 1981
Place Sebastian Cemetery
Disposition
Sebastian Florida
This permit must be endorsed by the sAton or person in charge (or by the funeral director when there is no sexton) and returned
within 10 days to the local county health department.
HRS Form 326 (1/77)
block 31 Lots 3,
Unit 2
Miller, Ralph Carl (Interred) Deed #178
Miller, aA,rw g,
Apartment 22
1805 — 19th Place
Vero Beach, Fla.,
Clara Miller interred March 2, 1981 Lot 4
Paid by Generai Receipt No. Pars. Ck. Deed # 178
Dated.... 3 -28 -72
ast Price $ 100.00 G.
Clara /miller
Discount Maximum No. Burial spaces 2 1805 — 19th P
$..... -.... Uero Be lace, APt. 22
Net Paid 100.00* ..... Totai area in square feet Beach, Fla.
$• * ................
Monument '
Permitted ....... f l a t Lots 3& 4
(Data above this line for City Record only) Blk• 31, Unit #2
nJ CEM
Index:
City of Sebastian, FL - Cemetery Lots
Last Name MILLER First Name RALPH CARL
Address 1
Address 2
City
State Zip
Deed # 178 Date Amount
Unit # 2- Block # 31
Lot Number 3 Interred MILLER, RALPH CARL (yet)
Lot Number 4 Interred MILLER, CLARA
Lot Number Interred
Lot Number Interred
Comment Clara has no marker
Comment
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