HomeMy WebLinkAbout2-05-08DEED #395
Marian F. Tracy
Paid by General Receipt No.
.......... Dated. 4 -17 -80 ... ....... •
8145 Brevard Ave
Roseland, F1
200.00
List Price $ .................
2
Maximum No. spaces • • • • • • • • • • •
Chas . F .Tracy
in t red
8rb
Discount $... - .............
Total area In square feet ................
4 -1
200.00
Net Paid $ ..................
flat
Monument permitted ..... ..... .........
LOTS 7 & 8
_
BLK 5 Unit
L
(Data above this line for City Record only)
R &R Attached
az`
Mrs. Charles F. Tracy (Marian)
8145 Brevard Avenue
Roseland, F1 32957
Mr. Charles F. Tracy interred 4 -19 -80 (Cox Gifford)
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3 1 R I C l! 1" V L V H I IJ A
DEPARTMENT OF HEALTH AND REHAHILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL - TRANSIT PERMIT
A 7A 8" 13,5- Z/ ol_
NAME OF First
DECEASED
Middle Last
DATE Month Day Year
(Type or print)
C
F_ TRACY
OF
i DEATH April 17_ lqgn
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME OF Ill not in hospital, give street address)
COUNTY
HOSPITAL OR
In&= River
Roseland
INSTITUTION
Attending Physician [X
(Name of Medical Certifier) (Address)
Medical Examiners 11 Michaela
A. Tovatt, M.D., 2300 Fifth Avenue, Vero Beach Florida 32960
Funeral (Name)
(Address)
Home Cox- Gifford - Baldwin Funeral Home 1950 20th Street Vero Beach Florida 32960
Check A ❑ A completed certificate of death accompanies this application.
One
B [I Dr. _ Hliehae =a- -Tevat was contacted on 1 1_7, '1980
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
(Signatu
Funeral
Director
,19 .
(Fla. Lic. No.)
/r&2% 111550
BURIAL TRANSIT PERMIT
(Date Signed)
it 17, 1980
Permit
No. 41 - 200
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 — Date i /:(.CJ ` '. / L
Registrar J A fLd(.(% Issued _Jy.
CEMETERY OR CREMATORY
Method of Disp ition Date of / / �pD
Bt Disposition a
-1 CREMATION
STORAGE Place of
OTHER(Specify) Disposition
Signature of 6wiiiess
" Person in Charge
� J
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 1;77)