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BLOCK 37
DEED #I 510
RECEIPT # 324
UNIT #1 ADDITION LOTS �9 & 10
WILLI�IM STEINACHER - INTERRED LOT #9,
Z2-3-82 .
DEED ISSUED 12-3-82 TO MRS. ANNA STEINACHER
ANNA STEINACHER INTLP.I�ID 10/9/87 - LOT 10
Paid by CEMETERY Rece�pt No. .,, 324 •
••.....Dated.,, 12-3-82
List Price s 450 00 ...:....... ........... ..
........s.........
NetPaids ,,,,450:00
R & R ISSUED
.• ANNA STEINACHER N�� U 510
Ma�cimum No. Puria! Spaoes . . . . . . .-. .1 -
"' - "6 P Palmers Court
Monument permitted , , , . . f1 a t, . . . . . . . . . ,gEg�TrAN � FLORIDA 32958
DEED # 510; RECEIPT !1324
(Data above t6L line !or (� LOTS 9& 10 BLOCK 37 , UNIT /�1 Ad
-- ��0� °p�'� WILLIAM INTERRED IN LOT 9 1�-3_g
STATE OF FLORIDA
�PARTMENT OF HEALTH & REHABILIT� SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL—TRANSIT PERNiiT
� 9 .� �� 7 G/i,�'%
A. (Type or Print)
1. Name of First Middle , Last DATE Month Day Year
Deceased William Richard Steinacher D ATH Nov. 30, 1982
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst. Sebastian River Medical Center
3. Name of Medical �Physician Address
Certifier Farha.t Khawaja, M.D. ❑Medical Examiner U.S. � 1 Fishcers Plaza Sebastian Fla.
'4. Funeral Home/ Name Address
�f9@��@t�[ Pottinger � Son Funeral Home S. Indian River Drive Sebastian Florida 32958
5. Check
Appro-
priate
Box
< �
6. Fune al Directc
B.
C�7
�
a� The medical certification has been completed and signed. A completed certificate of death accompanies
this application. �
b❑ was contacted on . He/she verified that
this death was from natural causes, that there was no accident nor oiher external cause of death, and that
will complete and sign the medical certification of
cause of death.
c � was contacted on _
Medical Examiner,
, � �rr�l�dical certifica n. ,�d ^ _
Sign
. He/she verified that
will complete and sign the
Fla. Lic. No./Reg. No. Date Si
BURIAL—TRANSIT PERMIT
�, /yd'�. �
Permit No. �S%— 7 �
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 /, 'A �� � Date �'�/���`-Y�.�G'�-�✓ f �O
Sub-Registrar Signature � �"'��-� �-'�'�-�`-l�l Issued � `�O�'�
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.
Method of Disposition:
�xcBURIAL ❑ STORAGE
� CREMATION � OTHER (Specify}
Signature of Sexton )
or Person-in-Charye 1
;d���il���:��]�a.:��i�il3�il:i 1
/._.e',�C'--�; �G- � /' j-�
Deborah Krape�. City C1erk
Place of Disposition Sebastian Cemeterv
Date of Disposition Dec . 3, 1982
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.)