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VITAL STATISTICS fj 02
APPLICATION FOR BURIAL-TONASIT PERMIT 75
NAME OF First
Middle Last
DATE Month Day Year
DECEASED
(Type or print) PETER
K. PAPPAS
DEATH Oct. 11, 1979
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME OF (If not in hospital, give street address)
HOSPITAL OR Sebastian River Med. Cen
COUNTY Indian River
Roseland
INSTITUTION
Attending Physician j,%
(Name of Medical Certifier) (Address)
Medical Examiners i l Dr. Phil D. Morgan, 1849 25th
St.. , Vero Beach, Fla. 32960
Funeral (Name)
(Address)
Home Cox — Gifford — Baldwin, 1950 20th St., Vero
Beach, Fla. 32960
Check A ❑ A completed certificate of death accompanies this application.
One
B [4 Dr. Phil D Morgan _was contacted on Oct. 12, ,1979
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
ture) (Fla. Lic. No.)
Funeral #595
Director
BURIAL TRANSIT PERMIT
(Date Signed)
Oct. 12, 1979
Permit 5-187-1979 No.
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.
L} A five day extension of time for filing the death certificate has been requested and granted.
Signature of Date
Registrar , Issued Oct. 12, 1979
CEMETERY OR CREMATORY
Method of Disposition Date of
X' BURIAL Disposition October_?,,_
.
7] CREMATION
STORAGE Place of
Disposition Sebastian Cemetery
OTHER(Specify)
er
Signature of Sexton �\— ! �
or Person in Charge (�-j� �u� CITY CLERK CITY OF SEBASTIAN.
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 (1/77)
o
Al
Via.