HomeMy WebLinkAbout2-20-12-McDONALD „A. t9 (qG
McDONALD)
Lavinia interred - Lot 12 - 11/21/88
UNIT 2, Block 20, Lots 11, 12
117 11 BALANCE
cc,
Name
Unit
Block
Lot
Date of Mark-out
Date of Burial
Name of Funeral Home
Authorized by
SD
Time 3 00
6- -.L
STATE OF FLORIDA
DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL — TRANSIT PERMIT ,
A. (Type or Print)
1. Name of First Middle Last
Deceased Lavinia Thorpe Towsley
2. Place of Death City, Town or Location Name of
County Hosp. or
Brevard Melbourne Inst.
x,19'
DATE Month Day Year
OF Nov. 17, 1988
DEATH
(If neither, give street address)
Holmes Regional Medical Center
3. Name of Medical {`Physician
Certifier Douglas Sorensen, M.D. ❑ Medical Examiner
4. Funeral Home/ Name Address
Direct Disposer Brownlie & MaxwelL Funeral Home, 1010 E. Paln etto Ave. , Melbourne, Florida
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
Dr. Sorensen's office
Address
200 Michigan Avenue, Melbourne, Florida
5. Check
Appro-
priate
Box
6. Funeral Director/
Direct Disposer
a El
b
rfse of death.
edical certification.
VOW
was contacted on 11/18/88 He /she verified that
this death was from natural causes, that there was no accident nor other external cause of death, and that
he will complete and sign the medical certification of
Signature
was contacted on He /she verified that
, Medical Examiner, will complete and sign the
596 November 18, 1988
Fla. Lic. No. /Reg. No. Date Signed
B.
BURIAL — TRANSIT PERMIT
Permit No 4 9 9C' 9
Permission is hereby granted to dispose of this body. tt
aA five day ext nsion of time for filing the death certificate (exclusive of weekends) has been requested and
granted. f iy nnot be 1 d it in this time limit, a "Funeral Director /Direct Disposer Report" will be filed
with thq'LgC Registraf/o it
p which death occurred.
Registrar or
Sub - Registrar Signature
Date November 18, 1988
Issued
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature Medical Examiner Date
or
Medical Examiner,
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.
, gave authorization by telephone to
D.
CEMETERY OR CREMATORY
Sebastian Cemetery
Method of Disposition: Place of Disposition Sebastian, Florida
Ei BURIAL 0 STORAGE Date of Disposition
0 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 County Health Department in the County where disposition occurred.
HRS Form 326, APR. 81
Ir�nl erns nrnvious od.i is ich ma he used
Index:RECORD #
NEWCEM
Record:723
Seat•ch h Field Contents
City of Sebastian, FL - Cemetery Lots
Last Name MCDONALD
Address 1
Address 2
City
Deed # Date
Unit # 2- Block #
Lot Number 11
Lot Number 12
Lot Number
Lot Number
Comment
Comment
Interred
Interred
Interred
Interred
First Name HARRY & LAUINIA
State
20
MCDONALD,
MCDONALD,
Zip
Amount
HARRY Dte Interred 19-64 -
LAUINIA CTOWSLEY) Dte Interred 11 -21 -88
Dte Interred
Dte Interred
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Monday, Feb 07, 2005 12:01 PM