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HomeMy WebLinkAbout2-06-14Paid by General Receipt No. , ,163... , ... _ .. , , Dated.10 - .46-79 ... . ............. Last Price $2Q.0-00 .. • • • • • Maximum No. Burial spaces .2.. . Discount $ .................. Total area in square fat .... ........... Net Paid $200 .00 Monument permitted . -G.17t .............. DEED #377 Henry & Aphrodite Preston 665 SW Vocelle Ave Sebastian LOTS 13 & 14 BLK 6 UNIT #2 r acnry and Aphrodite Preston 665 SW VOCell a Avenue Sebastian, F1 lh��Pr hftc �2/'SS ko-t I + (Data above this line for City Record only) R &R attached 777 s. DEED #377 Henry & Aphrodite Preston 665 SW Vocelle Ave Sebastian LOTS 13 & 14 BLK 6 UNIT #2 r acnry and Aphrodite Preston 665 SW VOCell a Avenue Sebastian, F1 lh��Pr hftc �2/'SS ko-t I + Burial Sebastian Cemetery STATE OF FLORIDA % i January 21, 1985 PARTMENT OF HEALTH & REHABILITE SERVICES VITAL STATISTICS APPLICATION FOR BURIAL— TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF APHRODITE M. PRESTON DEATH January 18, 1985 2. Place of Death City, Town or Location Name of (It neither, give street aaoressi County Hosp. or Tndian River Sebastian Inst. 665 S.W. Vocelle Avenue 3. Name of Medical [N Physician Aoaress Certifier Wiliam R. White MD E] Medical Examiner 2300 5th St. Vero Bea ch, Florida 4. Funeral Home/ Name Address Direct Disposer Cox– Gifford Funeral Home, 1.950 20th Street, Vero Beach, Florida 32960 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b fM Dr. White was contacted on 1- 18 -85. He /she verified that Box this death was from natural causes, that there was no accident nor other external cause of death, and that he 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. 6. Funeral Director/ Signature Fla. Lic. No. /Reg. No. Date Signed Direct Disposer .� 1 64j_ 1696 1 -19 -85 B. E./ BURIAL — T'R'ANSIT PERMIT Permit No. 1423-024 -85 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 Registr, r of the County in which death occurred. Registrar or Date Sub Registrar Signature Issued January 19, 1985 C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature Medical Examiner Date Of 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. Awaiting 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 1 '� Place of Disposition SEBASTIAN CEMETARY Date of Disposition JANUARY 21. 9 B 5 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.)