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DEED # 380
Paid by General Receipt No. .7,67 , , , , , , , , , , , Dated... 11/.5/.79 ................
Anna & Rebecca Loudermilk
List Price $.100.00• • • • • . . Maximum No. Burial spaces ...I . , , for Ben Maxwell (interred)
Discount $ .................. Total area in square feet .............• Rt . 1 Box 46
Net Paid $.100. 00, , , . , ... Monument permitted , Flat .. • .... , . • . .
R & R attached (Data above this line for City Record only) BLK 5, LOT 11, UNIT 2
DEED #380
MAMLL, Ben (interred 1115179) - Floyd Strunk
% Anna and Rebecca Loudermilk
Route 1, Box 46
Sebastian, Fl 32958
Block 5 Lot 11 Unit #2
cross referenced - Loudermilk
DEED #380
LOUD ZRMILK, Anna and Rebecca
Route 1, Box 46
Sebastian, Fl 32958
Block 5 Lot 11 Unit #2
Mr. Ben Maxwell interred in this lot on 1115179
Cross referenced - Maxwell
•VITAL
DFPARTMfNT OF HFAITH AND REHABILITATIVE SERVICES
STATISTICS
X
APPLICATION FOR
BURIAL -TRAP* PERMIT
Ben Edward Maxwell
NAME OF
DECEASED
First
Middle Last
DATE Month Day Year
OF
(type or print)
Ben Edward Maxwell
DEA1H November 3 1979
PLACE OF DEATH
COUNTY
CITY, TOWN, OR LOCATION
NAME OF (If not in hospital, qive street add.ess)
HOSPITAL OR
_ Indian
River
Vero Beach
INSTITUTION Indian River Memorial Hos .
Attending Physician TF1
(Name of Medical Certifier)
(Address)
Medical Examiners[]
Garrick
Kantzl er, M. D., #2 Breezeway
Bldg., Vero Beach, Florida 32960
Funeral
( Name)
(Address)
Home Floyd /Strunk
Funeral Home, 2405 14th Avenue, Vero Beach, Florida 32960
Funer
Di reel
Check A jN 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
on _ . - -- — - - -- - -- 19—__.
IFIa. lic. No.)
BURIAL TRANSIT PERMIT
(Date Signed)
Nov. 3, 1979
Permit
No._ 130 -546
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 Nov. 3, 1979
T� IF
I/
CEMETERY OR CREMATORY
Method of Disposition Date of
BURIAL Disposition Nov, 5, 1979 _
❑ CREMATION
❑ STORAGE Place of
❑ OTHER (Specify) Disposition Sebastian Cemetery —
Sebastian, Florida
Signature of bextorf-
-or. Person in Charge I
ri try r7,-rk
This permit must be endorsed by the sexton or person in charge for by the funeral director when there is no sexton)
and returned within 10 days to the local county health department.
HRS Form 326 (1/77)