HomeMy WebLinkAbout2-05-04Name
Unit
Block
Lot —
Date of Mark -out
Date of Burial Time Rio
Name of Funeral Home
Authorized by
Deed # 350
Bishop, Merle & Dorothy
101 Edward Drive
Whispering Palms
Sebastian, Fla. 32958
Block 5,
Lots 3 & 4; Unit 2
Merle interred 1181790 Lot 4 �-
by Colonial Funeral Home (Pottinger)
Paid by General Receipt No. . 1
List Price $. , • , •350 ;00
Discount $,,,,,
Net Paid $, , , 350.00
".
DEED #350 ,.
.......... Dated.. Xaxch .12,,..1979 ..... Mrs. Dorothy Bishop
Maximum No. Burial 101 Edward Drive
app "Z " Whispering Palms. Mobi 1 e Vi 1.
Total area in
square feet ................ Sebastian
Monument permitted ... ,F, - a t
"" Lots 3 & 4„ B1k 5�` Uni1Z
(Data above this line for City Record only)
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHARILITATI E SERVICES
VITAL STATISTICS ry N
A�LiGTiON POR iURI>i>tiL -1'� AMT
NAME OF First
DECEASED
Mi"o lost
TE Month Day Year
or print) Merle
Leonard BishO
7OF
DEATH January 8 19?
PLACE OF DEATH
COUN TY
CITY, TOWN, OR LOCATION
NAMIf not in hospital, piw street oddnssl
Indian River
Roseland
HOS(
INST�tian River Mod. Center
Attending Physician :F;
(Notre of Medical Certifier) (Address)
Medical Examiners ❑ Farhat Khaxa ja ,
M.D. P.O. 436 Sebastian Florida 32938
I
Hama Colonial Funeral Home S.
Indian River Drive Sebastian Florida 329
Check A [!PC A completed certificate of death accompanies this application.
One
B ❑ Dr. was contacted on , 19
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
jurisd,t' The body was released to me by
o /�' ,_ '
19
►Fla. lk. No.)
Funeral
Director
January 8. 1
(Date signed)
WANAL IRAMff FWMT Permit
No.- 79/6
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.
❑ A five day extension of time for filing the death certificate has been requested and granted.
Signature of
Registrar
Method of Disposition
:9 BURIAL
❑ CREMATt
❑ STORAGE
❑ OTHER (!
Signature of Sexton
or Person in Charge
This permit must be or
and returned within 1
MRS Form 326 (1/77)
Date
Issued J
came"" OR CN"TW
Date of January 11, 1979
niwomition
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