HomeMy WebLinkAbout1-B-1904/18/2011 13:21 3217242861
7303 Babcock St SE
Palm Bay, FL 32907
Office: 321- 768 -0776
Fax: 321 - 724 -2861
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To: K•%
FOUNTA`;NHEAD
PAGE 01/03
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Unit—
Block—
Lot
Date of Mark-out /3.
Date of Burial Time
Name of Funeral Home . 4!> Lpy7,g
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Authorized by
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Mica
Frances "Be rtie" Flood,,
-89, died -M- arch 30, 2013, at
Sebastian River Medical
[V Center in Sebastian
1, She was anative ofntus-
ville and lived in Mcco. I
She was of the ffaptist
faith
Survivors include her
husband, Calvin A. Flood
of WccO,* and son ' Robert
C. Flood of Grant.
She was preceded in
death by her son, Dwight
L D Flood- brother, Berton
'Granger; and sister, Jane
Delviiiia.
Services: Visitation will
be at 1 p.m with a funeral
service at 2 P.M. April 4 in
'the, Fountainhead Funeral
Chapel. Interment will foI,-
low in Sebastian Cemetery I
in Sebastian. - L
ELARI A DErA MEror' ,.' State of Florida, Department of Health, Bureau of Vital Statistics
R=AIN BURIAL TRANSIT PERMIT
DATE PRINTED: April 4, 2013 TRACKING NUMBER: 2013049469
1. DECEDENT INFORMATION
Name of Deceased Date of Death
FRANCES BERTIE FLOOD March 30, 2013
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER
Name and Address of Funeral Home /Direct Disposal Establishment Fla. Lic. No. /Reg. No. Phone Number
FOUNTAINHEAD FUNERAL HOME F056369 F056369 (321) 727 -3977
7359 BABCOCK ST S€ — — — — —
PALM BAY, FLORIDA, 32909
Funeral Director /Direct Disposer Fla. Lic. No. /Reg. No.
WILLIAM E. WELBORN F043463
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2013- FO56369 -5111
Date Issued: April 1, 2013
Meade Grigg, State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: SEBASTIAN CEMETERY
Method of Disposition: BURIAL Date of Disposition: j
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V- 1.011, Florida Administrative Code
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4369
RECEIPT
Name f(.,� I n -f-a -P r) f? ���� ®�
❑ Cash
Date `t - 1 J -
AJ
'Check #M&Q
No.
Amount Paid
001001208001
Sales Tax
001501322900
Garage Sates
001501341920
Copies/Bid Specs.
001501341910
LDC /Code of Ordinances
001501341930
Election Qualifying Fees
601010 343800
Cemetery Lots
LoMiche Block
Unit f
001501343805
Cemetery Fees
a/c..
150.00
�` Total Paid '00-0o
Initials
White - Dept. of Origin • Yellow - Finance • Pink . Applicant