HomeMy WebLinkAbout2-18-106.4.012/644G.A.
Paid by Gaaaraimafeript No. 545/4
List Price 8...150.40
Discount $
erD
Net Paid $..
Dated
?—//- 73
(:2)
Maximum No. Burial spaces
Total area in square feet
Monument permitted ..
2
Edward L. & Barbara E. Higgins
Bravard Avenue
Roseland, Fla (P. 0.
(Data above this line for City Record only)
Lots 9 and 10
Block 18
Unit 2
Box 87)
6eE64214
5 4
4.■.%
BLOCK 18
(Unit #2)
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL- TRANSIT PERMIT
NAME OF First Middle Last
DECEASED Barbara Enid Higgins
(Type or print)
DATE Month Day Year
DEATH April 14, 1980
PLACE OF DEATH
COUNTY Brevard .._
CITY, TOWN, OR LOCATION
Melbourne
NAME OF (If not in hospital, give street address)
NSTIITUTioNHolmes Regional Med. Cent,
Attending Physician] (Name of Medical Certifier) (Address)
Medical Examiners Li Robert Seelman, M.D. 200 E. Sheridan Rd. Melbourne, Florida 32901
Funeral (Name) (Address)
Nome Colonial Funeral Home S. Indian River Drive Sebastian Florida 32958
Check A [jc A completed certificate of death accompanies this application.
One
B ❑ Dr. was contacted on ,19
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
Funeral
Director
( ignature)
,19
1579
(Fla. Lic. No.)
BURIAL TRANSIT PERMIT
Permit 7 . (57 /
No ! ? 77
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
Registrar
Date
Issued
Method of Disposition
BURIAL
,-1 CREMATION
[ ) STORAGE
j OTHER(Specify)
Signature of Sextdrr
or Person in Charge
CEMETERY OR CREMATORY
Date of
Disposition
/(2*(-4:1-e--/
April 18, 1980
Place of
Disposition Sebastian C emPtery
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.
HRS Form 326 (1/77)