HomeMy WebLinkAbout2-08-08BLOCK 8
UNIT 2 LOT 8
Carl Grady Conaway Interred 1213183
#166 1115179
Paid by General Receipt No. #168 11116 DEED #381 — ``~ - --
' ' #169-12 /6• • Dated. ,
List Price $20D.Q0,,. ...'.''''''.''•••••••...... Van L. Or Evelyn 7. Pat
P. O. BOX 743 e
... Maximum No. ........ (loth Discount Burial spaces , 2 Sebastian Street)
$..•. -"" , PZ 32958
Net Paid $200.00 , .. , . • . • Total area !n square feet ......... _
Monument permitted .
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�R a tCh (Data above this line for Cit LOTS 7 & 8 BLK a
Y Record only) D UNIT #2
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STATE OF FLORIDA
/ARTMENTOF HEALTH & REHABILITASERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL— TRANSIT PERMIT
A. (Type or Print)
Middle Last DATE Month Day Year
1. Name of First
OF
Deceased
CARL GRADY CONAWAY DEATH November 29, 1983
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 Memorial Hospital
3. Name of Medical
Certifier Charles
Rattra , Jr.,M.D.
X Ph slcian Address
� Y
Medical Examiner 2208 8th Avenue.,Vero Beach, Florida
4. Funeral Home/
Strunk
Name
Funeral Home.,
Address
734 North Central Avenue., Sebastian, Florida
Direct Disposer
5. Check a
❑
The medical certification has been completed and signed. A completed certificate of death accompanies
Appro-
this application.
Pam
I 1 y) was contacted on 12/1 He /she verified that
priate b
Box
Og
Sec
th' death was rom atural causes, that there was no accident nor other external cause of death, and that
6. Funeral Director/
Direct Disposer
B.
's Or. Rattray
will complete and sign the medical certification of
cause of death.
c ❑ was contacted on . He /she verified that
Medical Examiner, will complete and sign the
medical certification.
Signature Fla. Lice. No./Reg. No. vain Q1911CV
�o November 30 , 1983
BURIAL — TRANSIT PERMIT
Permit No. 1228-83-302
Permission is hereby granted to dispose of this body.
1[R] 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
Sub - Registrar Signatu
Date November 30, 1983
Issued
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.
Me od of Disposition:
BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER pecify)
Signature o+- 6ercta1- 1 ,�
or Person -in- Charge )
CEMETERY OR CREMATORY s A
Place of Disposition
Date of Disposition ��•j�j
Deborah C. Krages, cl4fy Clerk
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 County Health Department in the County where disposition occurred.
HRS Form 326, APR. 81
(replaces previous editions which may be used.)