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Home My WebLink About2-03-14Paid by Z=f ttbceipt No, .:?12, , , , , , , , , , , Dated ........ List Price Maximum No. Burial spaces 2 Discount $..... -- ............ Net Paid $.. *350.. p,Q* Total area in square feet .......... Monument permitted (Data above this line for City Record Orly) Deed # 333 Matthew & Florence Carroll Box 184 -C, Palm Avenue Mi cco, Florida Matthew interred 6 -1,?-78 Unit 2, Bl* 3, lots 13 & I#- DEED #333 , CARROML, MATTHEW & FLORENCE BOX 184 -C MICCO i UNIT 2, BLOCK 3, LOTS 13, AND 14 MATTHEW INTERRED 6/19/78 IN LOT 13 — - -- FLORENCE INTERRED 4/24/85 LOT 14 1,✓ 1-07 1,{ w� FLo;ZrZ:N 1?7 iep 44 A 3 d / t Ole 13 ` /6 fp-r-t- J6 Af- . cno DEED #333 , CARROML, MATTHEW & FLORENCE BOX 184 -C MICCO i UNIT 2, BLOCK 3, LOTS 13, AND 14 MATTHEW INTERRED 6/19/78 IN LOT 13 — - -- FLORENCE INTERRED 4/24/85 LOT 14 1,✓ 1-07 1,{ w� FLo;ZrZ:N 1?7 Name Unit Block Lot Date of Mark -out Date of Burial Time -Name of Funeral Home Authorized by FORT PIERCE CREMATORIUM P. O. BOX 777 FORT PIERCE. FLORIDA 33454 James Andrew Killgallon We hereby certify that these are a cremains of Affa The remains were received Cox-Gifford Funeral Home Vero Beach, Florida From funeral firm city and state 1423 - 128 -1989 Vero Beach, Florida Cremation Permit No. Issued at March 24, 1989 FORT PIERCE CRgemator UM Date $f Death Date of Cremation April 3, 1989 B xfc \ p V B. BURIAL— TRANSIT PERMIT Permit No. 759 -605 Permission is hereby granted to dispose of this body. ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has bee n requested and granted. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Re0ort" will be filed with the Local Registrar of the County in which death occurred. Registrar or Sub - Registrar Signatu C. AUTHORIZATION for CREMATION, DISSECTION or t3UH1AL— AI —btA Signature Medical Examiner Date .► or Medical Examiner, gave authorization by telephone to Funeral Director /Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48'vhours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemettery BURIAL ❑ STORAGE Date of Disposition April 24, 198 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) , or Person -in- Charge ► Deborah C. Kra,;:s, C C erk This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sexton) and returned within 10 days to the local County Health Department in the County where disposition occurred. HRS Form 326, APR. 81 (replaces previous editions which may be used.) � �� STATE OF FLORIDA f- E &PARTMENT OF HEALTH & REHABILITOE SERVICES VITAL STATISTICS APPLICATION FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF Florence Elizabeth Carroll DEATH April; 22, 1985 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. Humana Hospital Sebastian 3. Name of Medical ysician Address Certifier Farhat Khawaja, M.D. ❑Medical Examiner Bay Street Center Roseland Fla. Y 4. Funeral Home/ XffjWPottinger Name Address & Son Funeral Home 1200 S. Indian River Dr. Sebastian Florida 32958 5. Check a The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b ❑ was contacted on . Heshe verified that Box this death was from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death. c ❑ was contacted on . HeVshe verified that Medical Examiner, will complete and sign the medic ation. i 368 April 22, 1985 6. uneral Director/ Signature Fla. Lic. No. /Reg. No. ;Date Signed xfc \ p V B. BURIAL— TRANSIT PERMIT Permit No. 759 -605 Permission is hereby granted to dispose of this body. ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has bee n requested and granted. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Re0ort" will be filed with the Local Registrar of the County in which death occurred. Registrar or Sub - Registrar Signatu C. AUTHORIZATION for CREMATION, DISSECTION or t3UH1AL— AI —btA Signature Medical Examiner Date .► or Medical Examiner, gave authorization by telephone to Funeral Director /Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48'vhours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemettery BURIAL ❑ STORAGE Date of Disposition April 24, 198 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) , or Person -in- Charge ► Deborah C. Kra,;:s, C C erk This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sexton) and returned within 10 days to the local County Health Department in the County where disposition occurred. HRS Form 326, APR. 81 (replaces previous editions which may be used.)