HomeMy WebLinkAbout1-19-37 V
Charlie Savage
Fellsmere
Block 19, Unit 1 I-- n / 37
Lillian Savage interred 7-1980
/ 517 6/ 7 (7/ OFP.ARTMFNT or HEALTH AND RI-iIAIIR_IIAlIVI SI Hvid[S
VITAL STATIS1ICS e;
APPLICATION FOR BURIAL-TRANSIT PERMIT
NAME OF First Middle Last MATE Month Day Year
DECEASED OF
(l vpe of print) -.—,LILLIAN G. SAVAGE DEATH July 20, 1980
PLACE OF DEATH j CITY, TOWN, OR LOCATION NAME OF (If not in hospital, give street address)
C U TY
pn�ian River ! Sebastian HOSPIMAL OR INSTn5 tatstian River Medical Center
Attending PhyxiciaKOk (Name of Medical Certifier) ---- (Address)
Medical Examiners L. Farhat J. Khawaja, M.D. , Fisher Bldg. US 1 , Sebastian, Florida
Funeral (Name! (Address)
Home o e Floyd/Strunk Funeral Home. , 2405 14th Avenue. , Vero Beach, Florida ____I
Check A rj A completed certificate of death accompanies this application.
One
Khawaja July 21 , 80
B XCK 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 [Ji The attending physician was unavailable or this death comes within the Medical Examiners jurisdiction.
The body was released to me by
on ,19_ _.
Sig ur• (Fla. Lic. No l (Date Signed)
41,Fune / — — --
Dire or r.. 1382 July 21 , 1980
BURIAL TRANSIT PERMIT Permit 130_712
No.—!—
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.
1. A five day extension of time for filing the death certificate has been requested and granted.
Signature of., ) \ � 71)4A_. / ' Date `— _-
:� ,I-) Registrar, - �;�t .C.R_-,�..., I(1,__,I, 1 -- -- Is -• July 21 , 1980
CEMETERY OR CREMA ' • RY ,'‘
Method of Disposition Date of ( / 7 �0
!I�BURIAL Disposition _--. J _
CREMATION i
rl STORAGE Place f ��
! OTHER(Specify) Dispose tort 4"sue..! . - _
Ir
Signature of Charges /�G°'� �"
44 Person in Charge L
This permit must be endorsed by the sexton 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.
HRS Form 326 It'77)
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SA9A GE, Cr�lic J
UNIT 1 O.B., Block 19, Lots 21, 22, 23, 24, 29
c31 i , 38, 39, 40
a/k/a Lot 1 ?`,
/2t-t 4z, T 2
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Flock 19 Lots 21, 22 23, 2) , 25 unit 1 0.8.
a4),E ► 38, 3), Lo
a/k„ a Lot 1
Savage, C?:arlir:
Fe11e srlere
In/i7 S/51
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