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DEED #408
BLOCK 37 LOTS 7& 8 UNIT 1 ADDITION
�
Robert Crerar, Jr.
Be rry & Josie Sts
P. O. Box Z92
Roseland, FI 32957
Name
Robert Crerar, Jr., interred
in Lot 8 - 6/11/89
Unit � � �,f,, ��, _
Block
Lot
Date of Mark-out
Date of Burial Time � L�'� �"" /.ii
Name of Funerai Home � /� ����'
.__. ..___. . . . .. __. .. T� �� � . �.
F [F
Authorized by �� ��"' �
� STATE OF FLORIDA � �
�EPARTMENT OF HEALTH & REHABILI�VE SERVICES
VITAL STATISTICS %� 3'
Ik:YARTME:�'T OF ryFnLlll nNU
HEHAdILITATIVFSFRYICFS APPLICATION FOR BURIAL—TRANSIT PERMIT � f�
A• (Type or Print)
1. Name ot First Middle
Deceased Last DATE Month Day Year
ROBERT JOHN CRERAR SR. OF
� DEATH JUNE 8, 1989
2. Place of Death City, Town or Location Name of (If neither, give street address)
County
BREVARD Hosp, or
MELBOURNE Inst. HOLMES REGIONAL MEDICAL CENTER
3. Name of Medical � Physician
Certifier CHARLES H. CROFT, M.D. Address 725-4500 Phone Number
❑ Medical Examiner 200 E. SHERIDAN ROAD, MELBOURNE, FLA.
4. Funeral Home/ Name
Address Phone Number (Area Code)
�i'Xt��s�r STRUNK FUNERAL HOME 1623 N. CENTRAL AVE. SEBASTIAN, FLA. 407-589-1000
5. Check a� The medical certification has been com let d d'
Appro-
priate
Box
6. Funeral Director/
�ispocer
p e an signed. A completed certificate of death accompanies
this application.
(� 1�NR�E was contacted on 6/8/Ag within 48
hours after death. He/she verified that this death was from natural causes, that there was no accident nor
other external cause of death, and that DR. CROFT
and sign the medical certification of cause of death. will complete
�
medical certification.
re
was contacted on . He/she verified that
Medical Examiner, will complete and sign the
Fla. Lic. No.lR�g.p��
��1672
Date Signed
6/8/89
°' BURIAL—TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-89-267
❑ 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 oc-
curred.
❑ No extension of time for fili the death certificate
Registrar or � ��/
Sub-Registrar Signature Q:--��G P .
Date Dat2 Certificate
Issued: - 6�8�89 Due:
�• 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 Medica� Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours atter
death is required for all cremations.
�❑
Method of Disposition: �
� BURIAL ❑ STORAGE
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person•in-Charge )
CEMETERY OR CREMATORY
Place of Disposition SEBASTIAN CEMETERY
Date of Disposition JUNE 11 z 1989
. �
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, May 86 (Replaces Apr 81 edition which may be used)
(Stock Number: 5740-000•0326-2)