HomeMy WebLinkAbout2-05-16DEED #354
Paid by General Receipt No. ..1.36 Dated Matt . 4 ,, , J9 79 ...........
Mrs. Lillian Garris
List Price $..ZQQ..Q.Q....... Maximum No. Burial spaces .1.......... Lot 12, Jays Drive
Discount $ .................. Total area in square feet ................ P. O. Box 875 Sebastian
Net Paid $...00.00_...... Monument permitted .Flat .............. LOT 16 BLOCK 5, UNIT 2
(Data above this line for city Record only) For: Alfred Garris interre4
318179
77 �'
J.
I
Mrs. Lillian Garris
Lot 12, Jays Drive
P. O. Box 875
Sebastian, F1 32958
Alfred Garris interred March 8, 1979.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BUMM-TRAS PERNUT
NAME OF First
Middle lost
DATE Month Day Year
OF
DECE o, P,,n,l Alfred
George Garris
DEATH March 7, 1979
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME Of
AL OR
(if not in hospirol, give street address)
COUNTY
Indian River
Vero Beach
INSTIT INSTITUTION
Indian River Mem. Hospital
Attending Physician flilen1e of Medical Certifier)
James Gordon 2300 5th Avenue Vero Beach#
(Address)
Florida 32960
Medical Examiners C]
Funeral (Name)
Colonial Funeral Home S. Indian River Drive Sebastian
(Address)
Florida 32958
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 .
�-
(signature) (Fla. Llc. No.) (Do» Sigrnd)
Funeral
Director
-- - Permit ��� _l lit
Bull" T2~ PWMT No
7/