HomeMy WebLinkAbout2-04-05'aid by General Receipt No. .11.4 ..... ... .... Dated..... Jul y, , 31 �, , , ,Z 973
Jst Price $.* *200.00 ** Maximum No. Burial spaces ...
$... - -............ Total area in square feet ................
'et Paid * *200.00 ** Monument Flat
$ .............. permitted ..... .
(Data above this line for City Record only)
s
Deed # 337
Maxine & Gerald Adams
Rt. 1 - N. Central Ave.,Seb.
Blk 4, lots 5 & 6 Unit 2
Gerald interred 7112178
(lot 6)
VV
A k4 — Orr -:: Wr i�Lr{ rnl
SAT
(LcT 3 MUSr Oc C,Vfd � i3y.^� A
q
�o
/i ✓
�•Z
l j�
/S
6
A k4 — Orr -:: Wr i�Lr{ rnl
SAT
(LcT 3 MUSr Oc C,Vfd � i3y.^� A
ADAMS, GERALD & MAXINE DEED # 337
Rt. 1, N. Central Ave.
Sebastian
Gerald Adams Intered July 12, 1978
Lots 5 & 6, blk 4, unit 2
Maxine Adams interred 7%23/85
Lot 5
Name Al) h Y C
Unit_ %may,/ n
Block— Al -
Lot
Date of Mark -out
Date of Burial
l Time
Name of Funeral Home_ %' 1 f✓ �= J4 yl_. �r
sir
Authorized by— :LL'�Z� -!
I
STATE OF FLORIDA S
*PARTMENT OF HEALTH & REHABILITA9 SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL — TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
Maxine Myra Adams DEATH July 20, 1985
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. Indian River Village Care Center
3. Name of Medical M Physician Address
Certifier Michael Zimmer, M.D. ❑Medical Examiner 2300 5th Avenue Vero Beach, Fla. 32960
4. Funeral Home/ ottinger & Son FuneraPl Home 1200 S. Indian River Dr. ddresAebastian 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 . He /she verified that
Box this death was from natural causes, that there was no accident nor other external cause of death, and that
cause of death. will complete and sign the medical certification of
6. Funeral Director/
QXX9Ab=M10x
B.
C
C ❑ was contacted on . He /she verified that
Medical Examiner, will complete and sign the
e is � ifr --.- 110'2368 July 20, 1985
Fla. Lic. No. /Reg. No.
BURIAL — TRANSIT PERMIT
Permit No
Signed
759 -617
Permission is hereby granted to dispose of this body.
❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and
granted. If it cannot be filed within this time limit, a "Funeral Director /Direct Disposer Report" will be filed
with the Local Registrar of the County in which death occurred.
Registrar or
Sub- Registrar Si
Date
AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
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 hours after death
is required for all cremations.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition
Sebastian Cemetery
BURIAL ❑STORAGE Date of Disposition juty 23, t985
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton
or Person -in- Charge ► fit/ Z:4 �_4 " t4— 4
Deborah C. Krages, City dlerk
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.)