HomeMy WebLinkAbout1-22-17Name Unit Block
Lot
Date of Mark -out
Date of Burial f �*° % Timed
Name of Funeral Home Authorized by
DELRAY BEACH
Mildred Yates
Mildred Boyd Yates`; 86, died
April 20, 2006, at Lake View
Care Center, Delray Beach.
She was born in Ada, Ohio,
and moved to Delray Beach 11
years ago, coining from Fells -
mere.
She was a graduate of Vero
— Beach High School, class of
1939.
She was a homemaker.
She was a contributor to the
press. Journal with the news
of Roseland; and she was asso-
ciated with Yates Trucking in
Miami.
She was a member of Rose-
land' United Methodist
Church.
Survivors include her
daughter, Grace Yates Parkins
of Delray Beach; brother,
Charles Firman Boyd of Kill-
een, Texas; and two grandchil-
dren.
She was preceded in death
by her husband, Melvin Yates.
SERVICES: A visitation will
be from 6 to 8 p.m. April 25 at
the Strunk Funeral Home, Se-
bastian. A funeral service will
be at 2 p.m. April 26 at. the
Strunk Funeral Home Chapel,
Sebastian, with Rev. Buddy
Johns officiating. Burial will
folio w hn Sebastian Cemetery.
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EPARTMENT OF
FLORIDA iixi:
A (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
G 1 17
1. Name of
First Middle Last
Date
Month Day Year
Deceased
Mildred Boyd Yates
of
Death
April 20 2006
2. Place of Death
City, Town or Location
Name of (If neither, give street address)
County
b.
Hosp. or
was contacted on 4/24/06
Palm Beach
Delray Beach
Inst. Lake View Care Center
3. Name of Medical
Address
will complete and sign the medical
Phone Number
Certifier George
Sabates, . D.
6646 West Atlantic Avenue
C.
Medical Examiner 4Physician
Delray Beach, FL 33446
561- 637 -4125
4. Name of Funeral Home /RW;eet- �l
Address
Fla. Lic. No. /Reg. No.
Phone No. (Area Code)
Establishment
6. Funeral Director/
1623 N. Central Ave.
Si ure
. /Reg. No. Date Signed
Strunk Funeral
Home
Sebastian, FL
1228
772- 589 -1000
5. Check
a. U
The medical certification has been completed and signed.
A completed certificate of death accompanies this
Appropriate
application.
Box
b.
Terri
was contacted on 4/24/06
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Sabates
will complete and sign the medical
certification of cause of death within 72 hours.
C.
was contacted on He /she verified that
, Medical Examiner, will complete and sign the
medic I certifi n of godse&eath within 72 hours.
6. Funeral Director/
Si ure
. /Reg. No. Date Signed
Direet-aspe"r
X
4/21/06
B. BURIAL - TRANSIT PERMIT
Per i Sion is hereby granted to dispose of this body. Permit No. 1228 -06 -0171
A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician, has
been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within
72 hours.
No extension of time for filing the death certificate has been requested.
RegistfefeF.-. Date Date Certificate
Subregistrar Signature q,40, ,� Issued: 4/20/06 Dqe: 4/25/06
C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA
Approval Number: 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.
D. CEMETERY OR CREMATORY
Me od of Disposition: Place of Disposition Sebastian Cemetery
BURIAL STORAGE Date of Disposition yA !
CREMATION OTHER (Specify)
Signature of Sexton
or Person -in- Charge } j ;7,_
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.
Distribution: White: Cemetery or Crematory
DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740- 000 -0326 -2) Pink: Local Registrare1 �I Poyn
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3614
RECEIPT
Name'-
❑Cash
Date
^�-
'eck#
No.
Amount Paid
001001 208001
Sales Tax
001501 322900
Garage Sales
001501 341920
CopieslBid Specs.
001501341910
LDCICode of Ordinances
001501341930
Election Qualifying Fees
601010 343800
Cemetery Lots
LoUNiche , Block , Unit .+(
001501 343805 Cemetery Fees
j
Z/ /% — es xz =�
i
Total Paid �_
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant