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Paid by General Receipt No. ...176 Da 3/14180
ted..............................
Ust Price $ * * 400 .00 * *
• Maximum No. Burial spaces .4 . , ....... .
Discount $.,,,,,,,, Total area in
Net Paid $* *400.00 ** square fat ................
Monument permitted ........#f.,3 t; ...... .
R &R attached (Data above this line for City Record only)
Name
Block__ /'
DEED #1397
Ronald O. Heinicke
Cleveland Street
Sebastian, PI 32958
Catherine: interred Mar 8C
Lots 6,7,10 &11 BLK 7 Uz
Lot
Date of Mark -out
Date of Burial
Time
Name of Funeral Home X
Authorized by C: -� r ±,
CITY OF SEBASTIAN
CITY CLERK'S OFFICE ? `'
RECEIPT
Name r ?1 ❑ Cash
Date l ` 3� 'd XCheck#
AmountPaid
001001 208001 Sates Tax
001501 322900 Garage Sales
001501 341920 Copies /Bid Specs.
001501 341910 LDC /Code of Ordinances
001501 362100 Community Center Rent
001501 362100 Yacht Club Rent
001501 362150 Non Taxable Rent
it
001501 343800 Cemetery Lots
601010 343800 Cemetery Lots
Lot/Niche , Block Unit
001501 369400 Interment Fee /`�,4A
i
001501 369400 Weekend Service
680800 220681 Yacht Club Security Deposit
680800 220682 Community Center Security Deposit
680800 220683 Riverview Park Security Deposit
Total Paid LsZU1L
Initials
White — Dept. of Origin • Yellow — Finance • Pink - Applicant
FLORIDA DEPARTMENT OF
HEALT
A (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
o? - 7-1d
1. Name of First Middle Last Date Montn uay rear
Deceased of
Linda Jane Heinicke Death Jan. 26 2002
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Sebastian Inst. 1334 Schumann Drive
3. Name of Medical Address "" "c r""""'°'
Certifier Gerald Pierone, Jr., M. 3715 7th Terrace
Medical Examiner Physician Vero Beach, FL 561 - 770 -2664
4. Name of Funeral Home /Dheet-Bispbs'af Address Fla. Lic. No. /Reg. No. Phone No. (Area Code)
Establishment 1623 N. Central Ave.
Strunk Funeral Home Sebastian, FL 1228 561 - 589 -1000
5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. Harvey was contacted on 1/28/02
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Pierone will complete and sign the medical
certification of cause of death within 72 hours.
C was contacted on He /she verified that
Medical Examiner, will complete and sign the
medic4,6eificat2n,66se of death within 72 hours.
6. Funeral Director / 1� gn F.E. No. /Reg. No. Date Signed
1862 1/28/02
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228- 02-0042
F�A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within
72 hours.
No extension of time for filing the death certificate has been requested.
-Revist � Date Date Certificate
Subregistrar Signature Issued: 1/26/02 Due: 2/1/02
C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA
Approval Number:
Date
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.
Method of Disposition:
8 BURIAL STORAGE
FICREMATION OTHER (Specify)
Signature of Sexton
or Person -in- Charge
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
Date of Disposition %1-3 0 / 0 -Z--'
This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sexton) ana returnea
within 10 days to the local County Health Department in the county where disposition occurred.
Distribution: White: Cemetery or Crematory
DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740 -000- 0326 -2) Pink: Local Registrar