HomeMy WebLinkAbout2-09-16-- Mrs. Magdalen DEE Tabor
8985 US Hwy 1 (Micro)
1980, May 28,,,
Paid by General Receipt No. .195 ....... .... Dated. .. . .. ....... Sebastian. Fl
? George Hershel Tabor int
350 . DO Maximum No. Burial spaces .. ........ .
List Price $• • 5124180
.Total area to square feet BLOCK 9 Low 15 & 16
Discount $.... - ..... .. ,€.fat........... .
Monument permitted
Net Paid $-35a .0.0....... .
(Data above this line for city Record only)
R &R attached -
A.
Name of
Deceased
or Print
STATE OF FLORIDA
cPARTMENT OF HEALTH & REHABILIT, /E SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL — TRANSIT PERMIT
/- /6 16 9 a"?-
rst Middle Last DATE Month Day Year
OF
Mary Magdalene Tabor DEATH March 12, 1985
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst. Humana Hospital Sebastian
3. Name of Medical 42 Physician Address
Certifier Kip Kelso, M.D.
❑ Medical Examiner Sunset Blvd. Sebastian, Fla.
4. Funeral Home/ Name d
11�r*t }� dre Pottinger & Son Funeral Home 1200 S. Indian River Ii%. Sebastian Florida 32958
5. Check a axThe medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate b ❑
Box was contacted on . He /she verified that
this death was from natural causes, that there was no accident nor other external cause of death, and that
cause of death.
will complete and sign the medical certification of
c ❑ was contacted on . He /she verified that
me a certi
Medical Examiner, will complete and sign the
' a � n.
6. Funeral Director/
Si no a
Direct Disposer Fla. Lic..No. /Reg. No. Date igned
B• BURIAL— TRANSIT PERMIT 759 -599
Per No.
Permission is hereby granted to dispose of this body.
❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and
granted. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Report" will be filed
with the Local Registrar of the County in which death occurred.
Registrar or Date �� � // G
Sub- Registrar Signature Issued -!i li If
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature Medical Examiner Date
or
Medical Examiner, , gave authorization by telephone to
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.
D. CEMETERY OR CREMATORY
Method of Disposition:
BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge )
Deborah C. Kra
C1 e r
Place of Disposition Sebastian Cemetery
Date of Disposition March 15, 1985
This permit must be endorsed by the Sexton or person -in- charge for 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
(replaces previous editions which may be used.)