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NZrs � riar�a.erite hQ�i��� �• � � ��" � L� . t??�1TT 1, Black 3b, Lots lI, 12 �t'e�orc�J�+Ibn irl�earred �1��-�� ���- � � �� i � on � ,��. �a� 1,.�-i� �� l�I� ���- �� Deed �1i.�.6 ` — � % — �� ��� 7 � Deed #146 � Paid by Genesai Receipt No . ............ .... Datefl...�:t��„ ....,. Gregory & marguerite Dillon L;st Price $...�:sd :.� �olares Street, Twin Lakes �aximum No, Burisl spacea ...�.... Sebast].�� Fla. 39958 �-r"'�. � Discount $............�� Total area in sqnare feet �:r ......... Net Pnid ¢..lS—�.%....... Monumeat permitted ��........ Lots 11 & 12� of Block 36 �s--�—�--r (Data above ffiis line for City Iiecord only) , u�:r -- . Name Unit BloCk Lot Date of Mark-out �a"� 9' q3 Date of Burial l�'�'��i Time l/ f'Dl� � Name of Funeral Home ���� Authorized by ' ' �� � La� t i��rn� Addr�s� 1 Add�-°es� 2_ C i. �, � De�d � lJnit �� L�t �laamka�r LQt Nur�b�r fil LO"� �lJCia�7�i"' �Q� �l,i4T9��'i' C0111tt1�'9'1� �.C✓;Yi�'��:: o"?"'t". � City of S�basti�n, FL - Cem�tery La�s DILLON F'zrst hlame GREGORY & MARGUERITE DOLORES STREET SEBASTIAN 146 Dat e 1- B1oGk # 11 Interred 12 Interr�d Z ['I't �t't"�f.� � fl'� �!°'i'�'C'� <D>e �ta±e FL 36-2�-�0 Amount GREGORY M. DILLON (vet) Marguerite Dillon �i� 32958- � 150. Dte Tnt�� r�d 11-02-93 Dte Interr�d 2- 4-95 �f � T flt �i'i"EC� �'�� Ifl't�C'i�C� e <N>ext <P>rev <R>e-search <L>abel <T>a�a <Esc> � State of Florida, Departm�f Health and Rehabilitative Services, Vital stics SIT PERMIT � F� /'�� / �-�' � �� � APPLICAT FOR BURIAL — TRAN L' _�- A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Gregory M. Dillon OF 10/29/93 DEATH 2. Place of Death County Indian River City, Town or Location 3. Name of Medical Certifier Muhammad Farooq, M.D. Vero Beach 4. Name of F�neral Home/ Direct Disposer Strunk Funeral Homes, P.A. 5. Check Appro- priate Box 6 Place of ''�"a�`' Final Disposition: � Funeral Director/ B. Name of (If neither, give street address) Hosp. or Inst. Indian ftiver Memorial Hospital Medical Examiner Address 777-37th St. Ste A-104 Phvsic:ian Vero Beach, Florida 32960 rnone rvumoei (407)567-2277 Address Fla. Lic. No./Reg. No. Phone Number (Area Gode) 1623 North Central Avenue Sebastian, F1 32958 1228 (407)562-2325 a❑ The medical certification has been completed and signed. A compieted certificate of death accompan�es this application. b� Sharon was contacted on 10/29/93 Within 72 hours after death. He/she verified that this �t�mv�sdfrc�ma1,n��uLal c�u�es, that there was no accident nor other external cause of death, and that �; will complete and sign the medical certification of cause of death. �� was contacted on . He/she verified that , Medicai Examiner, will complete and sign the medical certification. In state cemetery� Indian River ematory - am county: Signatur F.E. No./Re�-Alo. � - 1672 � BURIAL — TRANSIT PERMIT Removal from state Permit No. � � Donation Date Signed 10/29/93 1228-93-0484 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 as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a"Funeral Director/Direct Cisposer Report" wiil be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for fili the death certificate requested. Registrar or � Date O� 2� G3 Date Certificate Subregistrar Signature L" �` Issued: � l Due: C. � Signature or AUTHORiZATION for CREMATION, DISSECTION or BURIAL—AT—SEA , Medical Examiner Date Medical Examiner, , gave authorization by telephone fo — 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 eremations. Methods of Disposition: � BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge ) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition -5g�+�5f ��^ �r�'� t-- Date of Disposition �o�lEml�« .2 i 9 2 3 This permit must be endorsed by the Sexton or person-in-charge (or by the Funerai Director/Direct Disposer when there is no Sexton) and returned within 10 days to the local HRS County Public Health Unit in the County where disposition occurred. HRS Form 326, Feb 89 �Replaces Oct 87 edition which may be usedl (Stock Number: 5740-000-0326-2)