HomeMy WebLinkAbout2-30-04L
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19VRAT., Mrs. Grace L. (INterred)
LEVRAT., William J.
UNIT 2, Block 30, Lots 3, A
INTERRED: William J. Levrat Lot ##, 5-26-81
Deed #228
Paid by General Receipt No . ..... ........ Dated ... F0.2%.19.74 ......... Wm. J. Levrat (for Mrs.Levrat)
jlist Price $...... ?PP.*. Oil - . Maximum No. Burial spaces ..... 2 ..... Breezeway Trailer Park
Discount $ ........... ....... Total area In square feet ................ Micco, Fl
00
Net Paid $ ........ 200........... Monument permitted .... flat ........... Lots-.L& 4 Block 30, Unit #2
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(Data above this line for City Record only)
Vr) - -
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS `
APPLICATION FOR BURIAL -TRAkwIT PERMIT
NAME First Middle
DECEASED Last L DATE Month Day Year
(Type or print) William DEOF M 21
DEATH 1931
PLACE OF DEATH CITY, TOWN, OR LOCATION NAME OF (If not in hospital. give street address)
COUNTY HOSPITAL OR
De�OtiO Arcadia INSTITUTION G. pierce °
Attending Physician
(Name of Medical Certi!ler) (Address)
Medical Examiners ❑ Dr. "arrett M. Black M. D. F.O. hoX 299 Arcadia Florida --392
Funeral (.Name)
Home RobartS- ;radar Funeral tome, P.O. BOX 47 Arcadia, i1aa 821 dressi
Check A [Z A completed certificate of death accompanies this application.
One
B ❑ Dr. was contacted on t9
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 ,
(Fla. Lic. No.) (Date Sied)
Funeral gn
Director
BURIAL TRANSIT PERMIT Permit
No._- 2'j5- 106-91
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.
❑ A five day extension of time for filing the death certificate has been requested and granted.
Signature of Date
Re istrar
g� "-":. <, Issued May 22, 1981
CEMETERY OR CREMATORY
Method of Disposition
XX
BURIAL
❑ CREMATION
❑ STORAGE
❑ OTHER(Specify)
Signature of Sexton
or Person in Charge -x I N I
i Jy I f .
Date of
Disposition Kati 26, 1981
Place of Sebastian Cemetery
Disposition Sebastian, Indian River Co. , Florida
This permit must be endorsed by the sexton 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.
HAS Form 326 (1/77)