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� Deed � 144 (mailed 3/17/70) �
, Paid by General Receipt No. .....Ck•......... Dated..... 3-6-7� .
.. .. ............... Ken Atha
List Price y.,,,15Q.00 . 2 Little Hollywood� (p,p,Box 21Eo
• Mnaimum Ir'o. Burial spaces . . . . . . . . . . SB b 3
� a tian) Florid
Discount $.. .-.. ... .... Total area in sqnare feet - a Sebastian �
Net Paid g...150..00..... ................ Lots 23 dc 24 Unit %#1
Monument permitted .... f�,8.t........... Blk. 36
(Data above this line for (�ty Record onlr) (� Harr�ri moller) � f`"��,..�..
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Name �7/�. �i� U � L�--� r%�
Unit �*
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BloCk
Lot
Date of Mark-out
Date of Burial f�� !� i�' Time d`'� �, C4,D ` :'�`"� �'
Name of Funeral Home ) l� ��� -
Authorized by
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� State of Florida, Departm f Health and Rehabilitative Services, Vital �stics • ���� ����
APPLICAT�FOR BURIAL — TRANSIT PERMIT �
U � `Rv n id.o�'
A. (lype or
1. Name of
Deceased
2. Piace of Death
County
Indian Riv
3. Name of Medical
Certifier
First Middle Last DATE Montn uay rear
Hildred G. Moller p�TH 01/03/92
City, Town or Location Name of (If neither, give street address)
Hosp. or '
Inst.
Vero Beach India 'v
Medical Examiner Address Phone Number
777-37th, _ M. D.
Muhammad Faroo M.D. rnysician ve o -
4. Name of Funeral Home/ Address Fla. Lic. No./Reg. No. Phone Number (Area Code)
Direct Disposer 1623 North Central Avenu
Strunk Funeral Homes P.A. Sebast'an -
5. Check a❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate .
Box b� ,�, o was contacted on n, /nn inn 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 Miihamma�l ga_rnn=, M D will complete
and sign the medical certification of cause of death.
c ❑
6• Place of S.�bastian
Final Disposition:
l• Funeral Director/
�3ires�--B►epese�- .
medical certification.
ter
In state cemetery/
�j crematory - nam�
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
Removal
River n from state n Donation
F.E. No./Re�-Ple- Date Signed
B BURIAL — TRANSIT PERMIT 1228-92-0003
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 Repo� Y' will be filed with the Local Registrar of the County in which death occurred.
❑ No extension of time for fil' the death certificate requ ted.
Registrar or ` Date O Date Certificat$ D C� G7�
Subregistrar Signature Issued: ' � Due: �� �-�
C.
�
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.
Methods of Disposition:
C�SURIAL
❑ CREMATION
Signature of Sexton )
or Person-in-Charge ) .
❑ STORAGE
❑ OTHER (Specify)
CEMETERY OR CREMATORY
Place of DispositionS�bast�3in CemeterY
Date of Disposition ..;]anr�ary 7 199?
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 HRS County Public Health Unit in the County where disposition occurred.
HRS �orrn 326, Feb 89 (Replaces Oct 87 edition which may be used)
(Stxl� Nurnber. 5740-000-0326-2J
L. Gene Harrls
Mayor
•
�
City of Sebastian
POST OFFICE BOX 780127 O SEBASTIAN, FLORIDA 32978-0127 Kathryn M. O'Halloran
TELEPHONE (305) 589-5330 City C�erk
December 23, 1987
Mr. Kenneth Atha
P. 0. Box 780210
Sebastian, Florida 32978
Dear Mr. Atha:
As per your request, this will confirm that deeds have
been issued in your name for the following Cemetery Lots:
Deed No. 144 - Lots 23 & 24, Block 36, Unit 1
(for Mr, and Mrs. Harry Moller - Harry
Moller in Lot 23) - Deed dated 3/6/70
Deed No. 147 - Lots 21, 22, 25, 31, 32, 33, 34, 35,
Block 36, Unit 1- Deed dated 5/29/70
Robert Atha interred in Lot 32
Very truly yours,
�� `t� � I-�? �GC�
Eliz beth Reid
Administrative Secretary
LR