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STINSON, A. L.
UNIT 1 0.B., Block 10, Lots 26ii 27, 28, 29, 30
a/k/a Lot 4
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46)14,)Cr/-b4Vel (9/124142'1)
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Name / ,IDA/ firii,s.on
Unit
Block ./0
Lot 6;262
Date of Mark-out
Date of Burial cs2/3/Y 7 Time 0.G
Name of Funeral Home itkIRVEY elharcif
Authorized by
t .b ?. �f r ,"
of a r i :�*3 l ! e "s .r s.n l t ' t
.Note G. A. Stinson•is•owner of ?
' West 1`of Lot #3, Sec. 9 Blk•# Q-
V (The west 'containl 10,graves hh E 1 I I i J•
1 - i I .�' t id 1 i
.i I i F �j 1. .X .f.-4'.-.1.:•::-.:L...-7. _ 1n1y .+,'_—'I ? ` _•• l: '� �"
. Albert L Stinson (Deceased). 111 I I
is :owner of East f Lot r
' Sec. .13.:i: 81 k A10 I i i t
. (The east 1 contains 10i _
` So.1-`�590�ravesj) r 1, i
Mr. Jack Stinson says if x x .
j the family tries to ;bury_
a ,
in the West ; of property :•i r• he wants to know. He'wants i
deceased to be buried in his, � N
own property which is the
1 East 1. 1 j 4 1IM► , .
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Ff State of Florida, Depart of Health and Rehabilitative Services,Vital istics L t
•17 �7 APPLICA FOR BURIAL — TRANSIT PERMIT 1
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
Marion Stinson DEATH January 29 1997
2. Place of Death City,Town or Location Name of (If neither, give street address)
County Hosp. or
Lee Fort Myers Inst. Hospice House
3. Name of Medical Medical Examiner Address Phone Number
Certifier
Brian Kim, MD i] Physician 13691 Metro Parkway Ft. Myers. Fl 768-5077
4. Name of Funeral Home/ Address Fla.Lic.No./Reg.No. Phone Number(Area Code)
Direct Disposer 1600 Colonial Blvd.
Harvey-Engelhardt-Metz Funeral Homes Ft. Myers, Fl 33907 2280 (941) 936-2177
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box b D Dr. Kim's of fire was contacted on 1/30/97 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 he will complete
and sign the medical certification of cause of death.
c ❑ was contacted on .He/she verified that
,Medical Examiner, will complete and sign the
medical certification.
6. Place of In state cemetery/ Sebastian Cemetery Removal
Final Disposition: I I crematory -name/county: Indian River County n from state n Donation
7. Funeral Director/ Signature F.E. No./Reg.No. Date Signed
9ifest-Dicp000r ,y:/c LJ jam^""_ /4 0t 1/30/97
B. BURIAL — TRANSIT PERMIT 2280-070
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 Report"will be fiied with the Local Registrar of the County in which death occurred.
❑ No extension of time for filing he death certificate quested.
RP ' r �.,¢ Date 1/30/97 Date Certificate
Subregistrar Signature �/1•C•s.••�"'"� 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.
D. CEMETERY OR CREMATORY /� •
Methods of Disposition: Place of Disposition y1,�r.intotca re 6'yrrl ejt.r
ZI BURIAL ❑ STORAGE Date of Disposition ,. t-I-Ltc�.. 3/ 199'7
/
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person-in-Charge) <.4 .1 , ei/et,,,k_
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 Form 326.Feb 89(Replaces Oct 87 edition which may be used)
tStock Number:5740-000-0326-2)