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June 10, 1981
Mrs. Mary D. Holtzclaw
2120 - 36th Avenue
Vero Beach, Florida 32960
Dear Mrs. Holtzclaw:
Enclosed, please find receipt #255-M in the amount of $20.00
for a 2' X 1' foundation„to be installed in Unit 1, Block C,
for Mr. Clyde Holtzclaw.
Very truly yours,
Elizabeth Reid
City Clerk
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NO. ‘.20, —/"6 .
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RECEIVED FROM .'Yp ol. f --
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c .t. \i-,14/ry ` DOLLARS
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Amount Paid B
Balance Due S
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"THE EFF�GENCV+UNE"AN AMPAO PRODUCT CITY OF S " , a: ),
i CLYDE A. HOLTZCLAW OR No S � i if
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I MARY D. HOLTZCLAW
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4111. STATt OF FLORIDA
EPARTMENT OF HEALTH AND REHABILITAT SERVICES �/ /! ' 2 ' r ��
VITAL STATISTICS ( C /R/f
ePPL ICA T ION FOR BURIAL-TRA PERMIT
NAME OF First Middle Last DATE Month Day Year
DECEASED OF Feb. 15, 1981
(Type or pant) CLYDE A. HOLTZCLAW DEATH
PLACE OF DEATH CITY, TOWN, OR LOCATION NAME OF (If not in hospital, give street address)
"taran River Sebastian SP
INS'FebesiRian River Medical CEnter
Attending Physici (Name of Medical Certifier) (Address)
Medical Examiners ❑ Kip Kelso, M.D. , P.O. Box 128, Sebastian, Florida
Funeral (Name) (Address)
Home Floyd/Strunk Funeral Home. , 2405 14th Avenue. , Vero Beach, Florida
Check A ❑ A completed certificate of death accompanies this application.
One
B 3X Dr. Kelso was contacted on FPh_ 1F, ,19 81 .
He has assured me that this death was from natural causes and that he will complete and sign the medical
certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medical Examiners jurisdiction.
The body was released to me by
on ,19
j
(-.ignature) (Fla. Lic. No.l (Date Signed)
Funeral -r /
Dire 2088 Feb. 16, 1981
—...g37 BURIAL TRANSIT PERMIT Permit 130-844
Permission is hereby granted to dispose of this body by burial, transportation out of state, storage or cremation. For cremation a
waiting period of 48 hours after death must be observed and the Medical Examiner's approval must also be obtained.
A five day extension of time for filing the death cerr.ficate has been requested and granted.
Signature of Date
Registrar !, /–C r � Issued Feb. 16, 1981
CEMETERY OR CREMATORY
1 Method of Dis osition Date of February 17, 1981
H BURIAL Disposition
❑ CREMATION
❑ STORAGE Place of
❑ OTHER(Specify) Disposition Sebastian Cemetery, Sebastian, Fr,
Signature of Sexton
or Person in Charge ___--1 //
This permit must be endorsed b. the s. ton or person in charge (or by the funeral director when there is no sexton) and returned
within 10 days to the local county health department.
Form HRS o 326 (1!77)