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Home My WebLink About2-01-07. I m Paid by General Reeeipts No.:a,..58.. ,'p4,, . ;53... Dated.. Mey. 14 . & APri1 14, 1976 List Price $.35.0..00......... Maximum No. Burial spaces ....2. , . , , , , Discount $... - ............ Total area in egaare feet ........ Net Paid $3-50.00...- - Monument permitted .... R &R atched (Data above this line for City Record only) WILSON, Mrs. Versie DEED #291 211 Edward Dr Route 1 Sebastian, FZ Clyde Wil -Rda interred 4114176 IN LOT 8 BLOCK 1, LOTS 7 & 8 UNIT #2 r Name V r- a S r 1� �j `ti� 1 °" � 54f1J � � � � 3 Yi P '� Unit Block Lot Date of Mark -out /v Date of Burial r �% :i Time C s�r i i Name of Funeral Hdme ! R y ';,j d Authorized by WILSON, Mrs. Versie 211 Edwards Dr Routel Whispering Palms Mobile Village Sebastian, F1 BLOCK 1, LOTS 7 & 8 UNIT #2 Mr. Clyde Wilson interred In April 14, 1976 in Lot #8 •" N.. HIDA DEPARTMiV O t. (TYPE) State of Florida, Department of Health, Vital Statistics 1 i APPLICATION FOR BURIAL - TRANSIT PERMIT q , Name of First Middle Last Date Month Day Year Deceased of Versie Nellie Wilson Death Dec. 11 2003 Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 13225 U.S. #1 Lot 25 Name of Medical Address Phone Number Certifier Edgar Blecker M.D. 10596 S. U.S. #1 Medical Examiner Physician Sebastian, FL 772- 581--0016 Name of Funeral Home /Q4ea.DWpoael Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 1228 772- 589 -1000 Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Kathy was contacted on 12/12/2003 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Blecker will complete and sign the medical certification of cause of death within 72 hours. C. was contacted on He /she verified that Medical Examiner, will complete and sign the m al Sprtifigon of cause of death within 72 hours. Funeral Director/ S' ure F.E. No. /Reg. No. Date Signed D+teeEBispeeer � 1862 12/11/03 BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228- 03-0506 A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. No extension of time for filing the death certificate has been requested. Date Date Certificate Subregistrar Signature A Issued: 12/11/03 Due: 12/16/03 AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date 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 deaf is required for all cremations. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL CREMATION Signature of Sexton or Person -in- Charge STORAGE Date of Disposition /,Z ZZ a ale 3 , OTHER (Specify) lis 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 ithin 10 days to the local County Health Department in the county where disposition occurred. Distribution: White Cemetery or Crematory 1326, 6197 (Obsoletes all previous editions) . Yellow: Funeral Director or Direct Disposer lock Number. 5j40 -000 -0326 -2) Pink: Local Registrar 7PM. Uryu.t. a , X31 k 1. r 7 -- -- 4-r T�n.Lr,t/�. I Z l 1 Is l 0 3 - 0.z.. -- — I I A, AA . ---- - - - - - -- CITY OF SEBASTIAN p CITY CLERK'S OFFICE 2 � 0 3 RECEIPT Na ❑ Cash Date eck fl,� No Amount Paid 001001208001 001501322900 001501341920 001501341910 001501341930 601010 343800 001501343805 . Sales Tax Garage Sales Copie4Bld Specs. LDCICode of Ordinances Election Qualifying Fees Cemetery Lots LotlNiche . Block Unit CemaWy Fees L Total Pa :%S, od Initials White - napt. of Origin • Yellow - Finance • Pink - Applicant