HomeMy WebLinkAbout2-05-01Cemetery
Paid by Ge4�l Receipt No. .....120 NOV. 13, 1978
.......... Dated ..............................
List Price $.. *350.00* Maximum No. Burial
spaces ....2.......
Discount $... Total area in square feet
................
Net Paid $.. *,350,,0.0. *.... Monument permitted ..........Flat
/Px (Data above this line for Clty Record only)
Name
Unit
Block
Lot !
Cate of Mark -out.
Date of Burial := r':! ! 'j
Time
Name of Funeral Homgl
Deed # 343
Thomas & Rachel Kaylor
140 Edward Dr. Whispering P
Sebastian
Unit 2, Block 5, lots 1 & 2
Thomas interred 10 -23 -78
Kaylor, Thomas P. and (wife) Rachel Deed #.
140 Edward Drive (Whispering Palms)
Sebastian, Florida 32958
Block 5, Lots 1 & 2, Unit 2
Thomas P. Kaylor interred 10/23/78
��,� 4T" *46 44 1
- State of Florida, Departmen of Health and Rehabilitative Services, Vital Sstics
APPLICATI6OR BURIAL — TRANSIT PERMIT
A (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased Rachel Kaylor OF
DEATH 08/21/96
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roe land Inst. Sebastian River Medical Center
3. Name of Medical Medical Examiner Address Phone Number
Certifier 13855 U.S. Highway *1 = -
4. Name of Funeral Home/ Address Fla. Lic. No. /Reg. No. Phone Number (Area Code)
Direct Disposer 1623 North Central Avenue
P.A. Strunk Funeral Homes. Fl 32958 1228 (407)562-2325
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box b [ was contacted on nQ 421 Ica within 72
hours after death. He /she verified that this death was from natural causes, that there was no accident
nor other external cause of death, and that rAnrge Mi r-ha I l F D. O _ 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. Place of Sebastian Cemetery JW state cemetery/ Removal
Final Disposition: a ry - na unty: Indian River from state Donation
7. Funeral Director/ ture F.E. No. /Reg. No. Date Signed
Glireef- BieHesar - 4MML I V & 12. (IA191 /q6
B.
BURIAL - TRANSIT PERMIT
Permit No. 1228 -96 -0388
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 filing the death certificate requested.
"eylSh u,. Date Date Certificate
Subregistrar Signature —P, — - Issued: a Z 1 9 Due:
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.
D. CEMETERY OR CREMATORY
Methods of Disposition: Place of Disposition ..:Cx
BURIAL ❑ STORAGE Date of Disposition
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton)
or Person -in- Charge)
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)