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ISI w ir,! EPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
IA VITAL STATISTICS Z / 3,'
•PPLICATION FOR BURIAL-TRA PERMIT ,�/1. l7%Q�' , �F
NAME OF ' First Middle Last DATE Month Day Year
'a °Type orSprDint) Albert L. Stinson DEATH January 29,1981
P1yACE OF DEATH CITY,TOWN, OR LOCATION NAME OF (If not in hospital,give street address)
COUNTY Lee Cape Coral IHNOSSTPI T INSTITUTION P P
Cape Coral Hospital
Attending PhysicIan ] Name of Medic I C r rfie I. ress)
Medical Examiners ❑ Dr. Thomas Hinkle 70g Del Prado �lvd. ,Cape Coral,F1.339o4
Funeral Tant Funeral eHOme 3740 Del Prado Blvd. ,Cape Coral, Florida. (I4
Home
Check A ®( A completed certificate of death accompanies this application.
One
B ❑ Dr. was contacted on ,19 .
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
Funeral
Signature) (Fla. Lic. No.) (Date Signed)
l
Director WA/ C 2125 January 30,1981
BURIAL TRANSIT PERMIT Neormit 662-L 1939
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 certificate has been requested and granted.
Removal - Indian River County, Florida
Signature of
estitt,u"
Joy. Date Registrar Issued January 30,1981
CEMETERY OR CREMATORY
Method of Disposition Date of Feb. 3, 1981
[ BURIAL Disposition
❑ CREMATION
❑ STORAGE Place of Sebastian Cemetery
❑ OTHER(Specify)
Disposition Chastidn , Indian River Co. , Fla.
•'e,' .- Lmac 1,� L. j ' - .=
Signature of Sexton `�
or Person in Charge ,1 Funeral Director
This permit must be endorsed by the sexton or person in charge (or the funeral director when there is no sexton) and returned
within 10 days to the local county health department.
HRS Form 326 (1/77)
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