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Name
Unit
Block
Lot
Date of Mark -out
Time
Date of Burial ! , '
Name of Funeral Home '
Authorized -by
BLOCK 7 LOTS 13, 14, 15 & 16
John J. or Catherine M. Weaver
Baird Avenue, p. O . Box 82
Roseland, PI 32957
UNIT #2 DEED #383
JOHN J. WEAVER INTERRED 211182 LOT 14
N i i , f
`// 0/96
Paid by General Receipt No. ....... ,171
Dates . x/.19./8.0..... .
Last Price $10D.Q0.,eaoh.lot
Discount $ four 10tS Maximum No. Burial spaces 4
�����• " " Total area in
Net P $ Q square feet .
Paid 4Q .40... ........
Monument permitted ..flat .............
R &R a tCh (Data above this line for City ----- -- _- ---- -, _ -- tY Record only)
DEED #383
WEAVER, John J. or Catheri
Baird Ave, P.O, Box 82
Roseland, Fl 32957
LOTS 13, 14, 15 & 16, BLK ;
unit 2
1. 13
State of Florida,�Wooartment of Health and Rehabilitative Sery ` ital Statistics /5 —7
® APPLICATION FOR BURIAL — TRANSIT PERMIT L/ 6 2_�_
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased CATHERINE M. WEAVER OF January 6, 1990
DEATH y
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. Indian River Estates Medical Center
3. Name of
Certifier
Gary Silverman
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Home
5
Check
Appro-
priate
Box
MEN
Address
Number
300 5th. Avenue, Vero Beach,F1a.32960 407 - 567 -7111
Address I Fla. Lic. NOJ Reg. No. Phone Number (Area Code)
1623 North Central Avenue
Sebastian Fla. 32958 1 #1228 407 - 589 -1000
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b
Dr. Silverman was contacted on 1/7/90 within 72
hours after death. He /she verified that this death was from atural causes, that there was no accident
nor other external cause of death, and that will complete
and sign the medical certification of cause of death.
c ❑
medical certification.
was contacted on . He /she verified that
Medical Examiner, will complete and sign the
6. Place of Sebastian Cemetery In state cemetery/geba tiap Ceq�etery Removal
Final Disposition: crematory - name /c y: Sebastian, Fla. from state Donation
i ure F.E. No. /Reg. No. Date Sign G
7• Funeral Director/ -,�,_� #1672 l
Direct- 9ief3ese�- ,�
B.
BURIAL — TRANSIT PERMIT
Permit No.1228 -90 -014
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 as undue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director /Direct
Disposer Report" will be filed with the Local Registrar of the County in which death occurred.
❑ No extension of time for filirn the death certificate re uested.
Registrar or Date Date Certificate
Subregistrar Signature Issued: 1 / 7 / 90 Due:
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature
or
, Medical Examiner 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. CEMETERY OR CREMATORY
Methods of Disposition:
® BURIAL
❑ CREMATION
Signature of Sexton )
or Person -in- Charge )
❑ STORAGE
❑ OTHER (Specify)
Place of Disposition Sebastian Cemetery
Date of Disposition January 10, 1990
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 local HRS County Public Health Unit in the County where disposition occurred.
HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740- 000 - 0326 -2)