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' ,.-.- . .:. ` .:�� ' .. .�� .::.... ....: .��: ..� � ,. „� ... . � � � .�- . �� . . ;� � ��� .'- �-- .' ... ': : . ' - � - � . . . � ' � I-.. '.�i�rfiix�; .�..w,er+e.'.'Ci � , .. +ri � W�..eu-ar�yM ..._ .-.. � . ..,.�. .. ,., ..,_ ..< . . . . i�����+ �.(���.. .. - �� , i .. .. _ . .... ., .: _ . . . . �:: ,:� .,. ._, .... , ..... , . . .. �. � ,:. :- -; . �. .��.. :�. .: . �:-:, _.�.. .,' - , .: ..:_.. .. �... . .�:.. . . -. . .. . _ .� . .. .�;. ::... ., . .; ..,. . �.� .. . �, ... . . ;. .. ..._.- .:.� _.. .,, - ..::.. ., ..;.; ._'. .. ..,� .. . >,. .:.�:�.: � .�.� . .. �::. : � .' >�.�: - -.'�:: ��-.�.- ;:.� :: ..:� ��.:�� -- � r Id S �in,��. J ,_ , f q -� ,� � �;' � Name �� A' e� ,�: �� �j f°,. _ �' , <�,ar�=} Unit �" Block Lot Date of Mark-out Date of Burial_ ,:;y�..,. j � fit ,.- �� �+� ,.,�; : 4`�;; . � 1 � �`j ''.� ; ,s_' r{_ ,' Name of Funer2�l Home Authorized by. _ �' y, �. ,.,-._ Time j ty 'r ,�: ,�.-,. _ ___. Deed # 147 Paid by General Receipt No. ,,. CheCk.. .... Dated....5/?g/70 ................ Ken Atha Little Hollywood, P.O.Box 218, List Price $...._600.00 Maximum No. Burial spaces ....8... Sebastian, Fla. Discount $........-......... Total area in sqaare teet ...............• LotS 21,22,25, 31�3�,32,34,35 Net Paid $ . . . . .6 00 ..0 D . . . . Monument permitted . . . . . . , . f 1 a t , , g 1 o e k 3 6 (Data above this line for City Record only) Uf11 t 7r-1 ATT?AR �- �ea �14 r 7"_ iJ?�?�.T I, ��_c�ck 3b, Lc�ts 21, 22, 23. 2Z�, � 31, 32, 33, 3�-:, 35 ..�:. Moll�rs Harry (Interred in 23) ���� �jy�i Mc�ll�r, ��rs. (reser$ed 2I�} �sa ,�x.���.� f�7/yd ,n,��„.�� ,�; ,�� , �A�,-. �o� 3.� ,�; f � ` .� l ,/' � � k j%� �, ,, 'y � ��/�; `� � �.-G `� �; -i `�i� i � �' 'j % �� . ! ? `�`'r %�,( - f r�,�'Z ., �?; , � i�a�;�c�. �., �ti�� -�-x-l�� (�� r1�71 � �.:t � � State of Florida, Depa nt of Health and Rehabilitative Services, Vi�tatistics APPLI�ON FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Deceased Kenneth 2. Place of Death County Brevard 3. Name of Medical Certifier Farhat Khawaja, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes 5. Check a � Appro- priate Box b � c ❑ City, Town or Location Little Holl Middle Medical Examiner Physician Address 1623 Nor Last Atha � �% r ;�l �� � DATE Month Day Year OF 04/15/97 DEATH Name of (If neither, give street address) Hosp. or inst.3965 River Oak Lane Address Phone Number 7754 Bay Street Sebastian. Flor h Central Avenue Fla. Lic. No./Reg. No.� Phone Number (Area Code) The medical certification has been completed and signed. A completed certificate of death accompanies this application. �.j rhol c was contacted on �¢�.�.� within 72 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 Farhat Khawaja, M.D, will comptete and sign the medical certification of cause of death. medical certification. 6• Place of SebSSt i 3t1 Cemetery Final Disposition: �• Funeral Director/ � „"�.'.ect n��.�� In state was contacted on . He/she verified that , Medical Examiner, will complete and sign the i Removal county: Itldi811 River n from state n Donation „ F.E. No./Reg. No. Date Signed g. BURIAL — TRANSIT PERMIT 122g—g7-0183 Permit No. 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 Disposer ReporY' will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filin the death certificate requested. �- � � �/ Date Date Certi ic� / � Subregistrar Signature � � .� Issued: �� S 9 Due: ��' � C. i] Signature or AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA , Medical Examiner 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 death is required for all cremations. CEMETERY OR CREMATORY Methods of Disposition: P�ace of Disposition �-��- -•—� ���� � BURIAL ❑ STORAGE Date of Disposition 1 i� /Y 4 7 ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton 1 or Person-in-Charge i .d.�.�,. � �'��1 This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer �vhen 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 891Replacas Cct 87 edition which may be osed) (Stock Number. 5740-000-0326-2) '��'� CEM Index:RECORD � NEWCEM Las t hla�� Address 1. Addre�5 2 Ci�y Deed �` Unit � Lot Numb�r Lot Number~ Lot IVumber Lcrt IVumber Comment Cornrn��at City of Sebastian, FL - Cemetery Lots ATHA First Name KEN P.O.BOX 218 LITTLE HOLLYWOOD �EBASTIAN State FL 147 Date 05-29-70 Amount 1- Block # 36 21 Int�erred Kenneth Atha(vet) 22 Interred Margaret Atha 25 Interred David Lee Athafcremains) 32 Interred ATHA, ROBERT (vet) ALSO LOTS 31,33,34,35 Zip 32958- �600 Dte Interred 04-18-97 Dte Interred 01- -02 Dte Inierred 06-27-97 Dte Interred -19-76 F>wrd <B>ack <E>dit <D>elete <N>ext <P>rev <R>e-search tL>abel '��'��,.�v � : i„'" � - i - --..—�-.�_..--�+.� �,.. ;,.,. _ . , . 'e < �-: ' a. a. _ tla.. 7�'' : .�tl�tt �fnsurttnre ,�1 ; � : P: O. BOX 218. .����, SEBASTIAN, FLORIDq 32956 . -:, �.t ' '.....'� � PHONE ; 589-<3.13 ���.- .� � ' . . �r . . �� . ... 1 ;� -�. . - � � . . . �, ; S�BAST�Aiv 'C"c�,��-�,eY LCN;r �' I .. '. . Q �� �'k� . 3G . , ' _ : � �- ". .:. .�..-: S .. . .. . . . .'� . . 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