HomeMy WebLinkAbout2-03-12DEED #370
Paid by General Receipt No. ...155 ... Dated..Sept.28, 1979......... Walter Campbell (deceased)
% Shirley Campbell Tyler
List Price $300.00 . _ ....... Maximum No. Burial spaces ......1..... 17500 NW 68th Ave
Discount $ .................. Total area ins qn are feet Miami, Fl 33105
Net Paid $, 300.00 Monument permitted ....... k'Jat........
R &R Attached (Data above this line for City Record only) BLK 3 LOT 12 UNIT #2
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BLOCK 3 LOT 12 UNIT #2
DEED #370
Walter Campbell - deceased ._. ........ ._...__._.._
Daughter: Mrs. Shirley Campbell Tyler
17500 NW 68 Ave f__ ........ ...
Miami , F1
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BLOCK 3 LOT 12 UNIT #2
DEED #370
Walter Campbell - deceased ._. ........ ._...__._.._
Daughter: Mrs. Shirley Campbell Tyler
17500 NW 68 Ave f__ ........ ...
Miami , F1
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DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES / / // .
VITAL STATISTICS h �r
APPLICATION FOR BURIAL -TRA18 PERMIT
NAME OF
First
Middle Last
CREMATION
DATE Month Day Year
ypeApri
or print)
Walte
Raymond C
ell
10 1979
PLACE OF DEATH
CITY, TOWN, OR LOCATION
NAME OF ( if not in hospital, give street address)
HOSPITAL OR
COUNTY Dade
Miami
INSTITUTION Jackson Memorial Hosp.
Attending Physician
(Name of Medical Certifier) (Address)
Medical Examiners
Joseph
H. Davis, M.D. 1050 N.W.
19 Street, Muni, Florida
Funeral ( Name)
Florida Mortuary Services 1495 N.W.
( Address)
17 Ave., Miami, Florida 33125
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
(Signature)
,19 .
1334
(Fla. Lic. No.)
Sept. 11,1979
(Date Signed)
Funeral
Director
BURIAL TRANSIT PERMIT Permit
No.
Permission is hereby granted to dispose of this body by burial, transportation out of state; - storaW 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
❑
BURIAL
❑
CREMATION
[-]
STORAGE
LJ
OTHER(Specify)
Signature of Sexton
or Person in Charge
Date Sept. . 11, 1 979
Issued p
CEMETERY OR CREMATORY
Date of
Disposition
Place of
Disposition
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 (1/77)
Artistry in C Granite - Marble
Memorials �/ Bronze
Merritt Monument Company, Inc.
4820 South U. S. Highway 1
Fort Pierce, Florida 33450
Phone: 464 -5547 or 464 -3755
November 17, 1980
FOT; AF71R(7`A j
CITY OF SEBASTIAN
SEBASTIAN CEPIETE'RY
SIZE: 24" x 12" x 4" TO BE SET FLUSH WITH THE GROUND
AND CONCRETE PIECED UNDERNEATH IT.
4" thick
BELOVED UrCLE --
WALTER R. CAMELL
SEPT. 159 1908 —SEPT. 10, 1979
Unit 2
Bids. f
Lot 12
APPROVED i,�,.
DATE s
'THEY HAVE NOT BEEN FORGOTTEN"
P"
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jyu��� 33105
DEED # 370 "
CAMPBELL, WALTER jqj 9
(deceased) BLK3 LOT 12 UNIT 2
Daughter: Mrs. Shirley Campbell Tyler
17500 NW 68 AVE
Miami, FL.
BLOCK 3 LOT 12 UNIT #2
Walter Campbell- deceased %q' %q
Daughter: Mrs. Shirley Campbell Tyler
17500 NW 68 Ave
Mi and , Fl
DEED #370 =;