HomeMy WebLinkAbout2-05-05D EED #371
Paid by General Receipt No. ..156....... .... Dated ... 9 /.2 &,17.9 ................. Edward O'Neill
List Price $.10.0..00........ Maximum No. Burials aces 140 A 81st Avenue
p " "1 " " "' ,Roseland, Fl 32957
Discount $................. Total area in square feet ................
Net Paid $1QO.QQ,........ Monument permitted .Flat .............. For: Elva S. O'Neill (del-)
' &R Attached (Data above this line for City Record only) BLK 5 LOT 5 UNIT #2
d /
V l W�
BLOCK 5 LOT 5 UNIT
Deed #371
Deed made out to: Mr. Edward b"Vei11
140A 81st Ave
Roseland
Deceased; Mrs. Elva S. O'Neill - Sept 79
;i l h I c ur r Lun l uA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
J N J� G1 pC VITAL STATISTICS
SAPPLICATION FOR BURIAL -TWAT PERMIT
NAME OF First
Middle Last
DATE Month Day Year
ype or prriint) Elva
Serena O'Neil
IDEATHSeptember 1 1
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME OF (If not in hospital, give street address)
COUI�ndian Rive
NSTPT ITA TION OR
140 A 81st Avenue
Attending Physician 1:1
(Name of Medical Certifier)
(Address)
Medical Examiners EJ x H.L.
Schofield,
Funeral ( Name)
(Address)
Home Colonial Funeral
Home
Check A ® 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 jurisdiction.
The body was released to me by
,19
C
,9,, av
1579 September 17-1929
iSignaturel lu (Fla. Lic. No.) (Date Signed)
Funeral
Director
BURIAL TRANSIT PERMIT Permit
No.— 7
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.
Signature
Registrar
❑ A five day extension of time for filing the death certificate has been requested and granted.
Date
Issued
CEMETERY OR CREMATORY
Method of Disposition Date of September 18, 1979
" BURIAL Disposition
❑ CREMATION
❑ STORAGE Place of
❑ OTHE_RISpecify)
- _.._ _.Disposition Sebastian Cemetery
Signatu of Sexton �j,
or Pers n in Char (/ � r,/
This permt,,must be end6rsed by the sexton or person in charge (or by the funeral direr r when there is no sexton) and returned
within 10 dayslb-the..local county health department. .... .. - ............. 11
HRS Form 326 (1/77)