HomeMy WebLinkAbout2-09-15Paid by General Receipt No. .:1.9 5 ............ Dated. May .?8 19 80
last Price $. 350.00 Maximum No. Burial spaces . 2.........
Discount $....- ............ Total area in square feet ................
Net Paid $. 350..0.0........ Monument permitted ... fZAt............
R &R attached (Data above this line for City Record only)
--reran, FZ
Mrs. Magdalen Tabor DEED #401
8985 US Hwy #1 (Micco)
Sebastian, F1
George Hershel Tabor interred
5/24/80
BLOCK 9 — Lots 15 & 16 Unit #Z
George Hershel Tabor interred 5,124180 Lot
Magdalen Tabor interred 3/15/85 Lot
15
16
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL - TRANSIT PERMIT
pis' .3 1 f/a
NAME OF First Middle Last
ype or pri t) George Herschel Tabor
DATE Month Day Year
IDEATIVay 22r 1980
PLACE OF DEATH
COUNTY Dian River
River-
CITY, TOWN, OR LOCATION
Roseland
NAME OF (If not in hospital, give street address)
NSTIIT HOSPITAL
River Med. Cent
Attending Physician ii (Name of Medical Certifier)
(Address)
Medical Examiners ❑ Kip Kelso, M.D. Sunset Blvd. Sebastian Florida 32958
F uneral ( Name) (Address)
Home Colonial funeral Home S. Indian River Drive Sebastian Florida 32958
Check
One
. -1
A ® A completed certificate of death accompanies this application.
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
on ,19
1579
(Signature) / (Fla. Lie. No.1
May 23, 1980
(Date Signed)
Funeral
Director
BURIAL TRANSIT PERMIT Permit o ,z
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 ) , .,L ) - Date
Registrar V ,_ L Issued
f .,
CEMETERY OR CREMATORY
Method of Disposition Date of
® BURIAL Disposition May 24, 1980
❑ CREMATION
❑ STORAGE Place of Sebastian Cemetery
❑ OTHER(Specify) Disposition
Signature a+-Se*um
or Person in Charge
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 (1/771