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Nameh_�
Unit
Block vw'
Lot
Date of Mark -out
Date of Burial _ ¢�
Time
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Name of Funeral Home
Authorized by
OHIO DEPARTMENT OF HEALTH
DIVISION OF VITAL STATISTICS
Form VS -14 (R 12/61) �...
NAME OF DE
PERSONAL
DATA ON SEX I A
DECEASED
CAUSE OF DEATH
BURIAL- TRANSIT P
PERMIT NO.
DATE OF DEATH
January 16.198
len
I Con estive Heart Failure
MANNER AND 9 BURIAL [1 CREMATION ❑ OTHER
PLACE OF 'R'
DISPOSAL NAME OF CEMETERY SPECIFY
COUNTY
Sebastian Cemetery Indian River
A SATISFACTORY CERTIFICATE OF DEATH OR PROVISIONAL CERTIFICATE OF DEATH HAYING BEEN FILED AS REQUIRED BY THE LAViIi
OF THIS STATE, PERMISSION TO DISPOSE OF THE BODY AS INDICATED ABOVE, IS HEREBY GIVEN TOE
AUTHOR- Strunk Funeral Home and /or
IZATION TO FUNERAL Vero Beach, Florida
DISPOSE OF DIRECTOR Hanson -Neely Funeral Home ADDRESS Ada. Ohio
BODY SIGN6FM OF REGISTRAR
REGISTRATION DISTRICT NQ. DATE OF ISSUE
3300 Jan. 17 1985
This permit must be retained by superintenden or person in charge of cemetery for a period of (5) five yeaw
k A
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U CE M
Index:
Last Name
Address 1
Address 2
City
Deed #
Unit #
Lot Number
Lot Number
Lot Number
Lot Number
Comment
Comment
<F <F >��
City of Sebastian, FL - Cemetery Lots
WILLIAMS First Name ORUILLE, OLGA & BETTY J.
wabasso
110 Date
2- Block #
9 Interred
10 Interred
11 Interred
Interred
State
02 -21 -68 Amount
31
WILLIAMS, ORUILLE
WILLIAMS, OLGA S.
WILLIAMS, BETTY J.
<D >elete <N >e
Zip
$225
Dte Interred - -73
Dte Interred 01 -20 -86
Dte Interred - -68
Dte Interred
arch <L >abe