HomeMy WebLinkAbout2-16-04Cremains�
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Paid bY eipt No. .. . .9Q. . . . .. . . . . . Dated. . . . . . . . .,�.�. .',`�"2. .`�1 �� / � 77
Iast Price �. .,SI'�.�' 00 Maximum No. Burial spaces 1
............
Discount $ .................. Total area in sqnare feet .......
.........
Net Paid �. . . .:i.7.��',� �.�, , , , , Monument permitted . . . . Flat
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(Data above Yhis line for City R.ecord only)
RUND, Harold E.
45 Alisa Drive
(Whispering Palms)
Sebastian, F1.
'/�� r-� 3/�
Harold E. Rund
45 Alise Drive
(Whispering Pa1ms)
Lot 4, BIk 16, Unit 2
C. R, #90
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Deed # 3I2�': �
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Lot 4, BZock Z6, Unit 2
��� ��� � Interred 4/21/77 — Cremains
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STA7E OF FLORIDA
�, ,EPARTMENT OF HEALTH & REHABILIT.,, ✓E SERVICES
VITAL STA7ISTICS
APP�.ICATION FOR BURIAL—TRANSIT PERNIIT
� � `�3/� Gr �.
A. . (Type or Print)
1. Name of First Middle Last DATE Month Day Year
peceased Harold Edward RUND �F Sept. 24,1985
DEATH
2. Place of Death City, Town or Location Name of (If neither, give street address)
County �n��� R3,ye� Roseland Hosp. or g150 135th Street
Inst.
3. Name of Medical Q Physician Address
Certifier RiC11�d J.Eisenmann, D.O [] Medical Examiner 7945 Bay Stxeet� Suite 4, SebaBtian�Fla.
4. Funeral Home/ grawnlie & Ma�x��"�t,�n���ii�pae���.D10 E. �almettA A�d;es
Direct Disposer �Ielbourr�e, Fla. 32901
5. Check a� The medical certification has been completed and signed. A completed certificate of death accompanies
Appra this application.
priate b❑ was contacted on . He/she verified that
Box this death was from natural causes, thai there was no accident nor other external cause of death, and that
6. Funeral Di'rectc
Qirect Disposer
will complete and siyn the medical certification of
cause of death.
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medica) certification.
Signature
596
25, 1985
Fl.a. Lic. No./Reg. No. Date Signed
��,_,�..,�..�_. _ ,,..,�._ .,._..,- _.,._,-_ ANSIT PERMIT 496C2� S �
.
Permit N.o. T- ......
B. —
Permission is hereby granted to dispc►se of this body. v`�" <� .
❑ A five day e nsion of time for filing the death certificate (exclusive of weekends) has been requested and
� granted.,lf ' nnat b filed within this time limit, a"Funeral Director/Direct Disposer Report" will be filed
with th Re is r of the ount in which death occurred.
� �.�9��� ,� Y
Registrar or
Sub-Registrar Signature
Date Sept. 25,1985
Issued
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
Signature , Medical Examiner Date
or
Medical Examiner, , gave authorization by telephone to
Funeral Director/Oirect Disposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the abave methods. A waiting period of 48 hours after death
�S �g�uirec�;�.���m*���'Q�F : ;:.; `„
�,: ��;,.,� � , ... ,
o• CEMETERY OR CREMATORY
Method of Disposition:
� BURIAL � STORAGE
Q CREMATION � OTHER (Specify)
Signature of Sexton 1
w Person•in-Charge 1
Deborah C. Kra
C1ty C
Place of Disposition Sebastian Cemetery, Sebastia
Date of Disposition 9/27 /85 Fla.
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 tocal County Health DepartmQ�t in the County where disposition occurred.
HRS Form 326, APR. 81
(replaces previous editions which may be used.)
�'� GE M
Index:RECORD #
Last Name
Address 1
Address 2
City
Deed #
Unit #
Lot Number
Lat Humber
Lot Number
Lat Number
Comment
Camment
City a� Sebastian, FL - Gemetery Lots
RUND First Hame HAROLD
45 ALISA DRIUE WHISPERIHG PpLM
312
2-
4
Date
Block #
Interred
Interred
Interred
Interred
CF?wrd CB>ack CE
Monday, May 23, 2005 10:11 AM
State
04-21-77 Amaunt
16
Z ip
$175
Recard:338
Harold Dte Interred 09-27-$5
Ruth Dte Interred - -77
Dte Interred
Dte Interred
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