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IRATE OF FLORIDA
„ DEPAIRIIENT OF HEALTH AND RENARD-RA ERVI(RII
DIVISION OF oHEALTH B
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Poet Oplao Oen MO milmm.M.,ModOs Permit No-41.m.a.
PERMIT FOR DISINTERMENT, TRANSPORTATION, AND REINTERMENT
Name of deceased .11.0in..Franklin Parker
Age 7.9 Race W Sex .14 Date of Death Sept. 2Q, 1928
Place of original burial Sebastian Cemetery, Sebastin, Florida
, .(Cemetery) . - , ,
'hA-11.4"sq) :1,4 Lin'
Place of reinterment Evergreen Cemetery, Okeechobee, Flori a
(Cemetery) r (Ad ress
Willad '0.1 Woods - •= "."."9 • ' 159•:!:' F‘,T:C1
Funeral director disinteriing.'
(Name) (License No.) .,. )1 v*e...-1,,
Permission is hereby granted to disinter, transport, and r " ter the body described abov subject to the regulations on the reverse
side of this form.
Date Permit Issued 2-11-77 Signed:...... . ...... ............ Registrar
Reg. Dist. No. 09 Address 25 14th. Ave. Vero Beach, Fla. 32960
Endorsement of agent of cemetery from which remains are to be disinterred: '
Date
Cemetery Agent
Endorsement of agent of cemetery in which remains were reinterred: .
Date
Cemetery Agent
This permit must be surrendered by the funeral director to the cemetery where reinterment is made. THE AGENT OF THE
CEMETERY (OR THE FUNERAL DIRECTOR IF THERE IS NO AGENT) MUST FORWARD THIS PERMIT WITHIN 10
DAYS TO THE LOCAL REGISTRAR OF HIS DISTRICT.
FORD V. R643 (Over)
Ta.ualuNp oqa .zolaasq3 issaunj aqp jo auzuu aq; Atolaq lutuad ata
Jo apls wosj aq; o; pappu aq pinoqs aureu sq 'Apoq aq .za;uTaa o sF aopailla reaaurq puoaas n uatta
-asociAnd it); paalnbaa l 1p.u.tad isuon
Ipps o •aspiruatoo Jacuta uounuoa Aq Spoq aq;Jo uogsvodsusal ao;uowszliotonn s vuuad siuj
.6poq aq;jo luauualulaa so; Sviotonu apytoad o puu sapiNp
o uosualuf aq; To paugou uaaq sag aus4spatt yea oa Amaaa o s ltuuad sun jo asodsnd
•S4polons re2ai sadosd
sato° so up Jo ;xau aq; um; paumqo aq ;mu uoTssp.u.zad ipatuao;.zad aq o s sdows uu aratint sasua
u/ •Aviotong ju2a1 sadoad mil so pasuaaap, jo upt jo ;xau aq l luau paupr4qo aq 4stuu os op al uols
-sputa,' 'Apoq aalulslp ol NT-r
al jbaiatnjiappq 3q4 aanua ;lam Aq lou saop jjKaad spjj,
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ATTILIMIVO SNOLLOLIILLSNI
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State of Florida
Department of Health and Rehabilitative Services
DIVISION OF HEALTH .'
SURSAU OF VITAL STATISTICS
PONT OFFICE. 11OX 210
• JACKROYV11d.K, Y1.O1t111A 82201
APPLICATION FOR PERMIT TO DISINTER,
• TRANSPORT, AND REINTER HUMAN REMAINS
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Name of Deceased John Franklin Parker
Age 79 Race White Sex Male
Date of death September 20, 1928 Place of death Okeechobee, Fla.
Place of original burial Sebastian Cemetery, Sebastian, Florida
(Cemetery) (Address)
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Place of reinterment • Evergreen Cemetery, Okeechobee, Florida
(Cemetery) (Address)
I herewith make application for a permit to disinter, transport, and reinter the
body described above. I understand that this permit will not by itself entitle
me to the right to disinter the body and certify that I have the authority of
the nearest living relative or other proper legal authority for such removal.
I also understand that the issuance of this permit will not authorize an autopsy
to be performed and permission for an autopsy must be obtained from the nearest
living relative or proper legal authority.
Date FPb_ 11. 1977 L71.." � ,t,,")X. ( �� 1159
(signature of funeral director) (License ■o.)
• Address P.O. Box 428 Okeechobee, Florida
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TO BE COMPLETED BY LOCAL REGISTRAR
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Permit No.
Date *permit issued //- \c). C).(- ZZ\
(signs ore of Lo-cal egistrar)
INSTRUCTIONS
FUNERAL DIRECTOR: To obtain a disinterment, transportation, and reinterment
permit, complete this application and submit it to the local registrar or
deputy local registrar of the district in which the body is buried.
LOCAL REGISTRAR: Issue a disinterment, transportation, and reinterment permit
upon receipt of a properly completed application signed by a funeral director
licensed in the State of Florida. Sub—registrars and deputy sub—registrars
are not authorized to issue these permits. This application is to be retained
by the local registrar.
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FORM V.S.#642 1
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