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HomeMy WebLinkAbout1-24-23 Name Do k, "") / AA 11, (2, ,4 i ,i-,4 '‘,..., '-' 4:...,Ar) A' 1 4 Unit 7; . Block Lot Date of Mark-out 8 / 8 . Date of Burial Tim 6 r •,'''21 3 le9 Pt / e 2.± (20 Name of Funeral Home / /4 / fr::- -42 Authorized by June 21, 1988 (date) I hereby certify that this urn contains the cremains of Dorothy K. McCain _ who died June 18 , 19 88 at Da y t o na Bch, county of Vol us La state of Fl or ida , and that the said remains were cremated June 21 19 PP Permit No. 123-3698 Signed TRI-CITY DIVERSIFIED SERVICES, INC. P.O. Box 15197 Daytona Beach, FL 32015 PHONE (904)255-7623 CREMA[NS OF DOROTHY K. McCAIN TO: DALE WOODWARD FUNERAL HOME HOLLY HILL, FLORIDA 1:1— . AP] OPARTMENT OF EA THO& REHABILITA• SEFVICES t VITAL STATISTICS APPLICATION FOR BURIAL—TRANSIT PERMIT // / L/, , A. (Type or Print) ' 1. Name of First Middle Last DATE Month Day Year Deceased OF Dorothy K . McCain DEATH June 1 8 , 1 988 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Volusia Daytona Beach Inst. Humana Hospital 3. Name of Medical Y4' Physician Address Phone Number CertifierDr. J .C. Jackson MD 0 Medical Examiner 4770 S . Atlantic Ave. Port Orange, F - 1. Funeral Home/ Name Address Phone Number (Area Code) Direct Disposer Dale Woodward FH 167 Ridgewood Ave Holly Hill , Florida 32017 5. Check a ❑ The medical certification has been completed and signed.A completed certificate of death accompanies Appro- this application. priate Box b !; et _ • was contacted on 6/1 8/88 within 48 – 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 Dr. Jackson MD 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. Funeral Director/ ' '� Si turL. Fla. Lic. No./Reg. No Date Signed Direct Diposer -____- \C`-- (Y �v vim_ R BURIAL—TRANSIT PERMIT Permit No. 123/3698 Permission i. hereby granted to .,ispose ot this oocy. A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted. If it cannot be filed within this time limit, a "Funeral Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death oc- curred. ❑ No extension of time for filing the death certificate requested. Registrar or Date /, le Data Certificate Sub-Registrar Signature�� e , /- -- �. A –Issued: l-V �U/ — Due: c AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA Signature ______ , Medical Examiner Date . --1 n r or Medical Examiner, fe lt ,me , gave authorization by telephone to �L" ... -• . - _Sr __ �_ e7 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 ITY DIVERSIFIED SERVICES, INC. Method of Disposition: Place of Disposition DA YTONA BEACH, FLORIDA ❑ BURIAL ❑ STORAGE Date of Disposition JUNE 21, 198 CREMATION ❑ OTHER ( '•e .ify) i Signature of Sexton )or Person-in-Charge I ,∎ 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 County Health Department in the County where d;sposition occurred. FIRS Form 326, May 86 (Replaces Apr 81 edition which may be used) (Stock Number: 5740-000-0326-2) Block 24 Lots 21, 22, 23 24 25 Unit 1 0.B. • 36, 37, 3 , 39, 40 a/k/a Lot 1, Herndon, Mrs. Sallie (Dorothy McCain) P o P o T N 7 /(c- C y,„/ 6/-1.3/88"� Lu r • o a� Oa:y 2/�� Oi ry ©�_ fiS7MCi JD,4n) 1\10E2, Covn)T∎' LQt i-E)i4 (Jo �iE'Ti F� I -144i-r- —77-1C ,A/ 6„ ._ ! S n o. �. ©'• ` (� F � rJ�ec,v-� ��mt�G2A`\ \cce2-i7S. O F I r_ rJ , oF T+IL • •LoG1 a 'LA 1:015 c is aa, 0� 3 o� `-Iti o� 5 36, 3 / 3 /5", o ,AQ *rre ,24E-c7 / C(:✓ AJ74mc.; of 1020-77,1 y Mc C-4/, .S - OCSit:1-(AJ, L • • • .c..teta of Florida • • s y?t^�sSosJ:f ..,:idi 3i Oct. 5, 1990 .. ;n•r. froti `�•���laxrn nco Inc. ■ "1,t, • GREENE & MASTRY, P. A. ATTORNEYS AT LAW Florida Federal Towers • Suite 1500 • 360 Central Avenue Post Office Box 3542 • St. Petersburg, FL 33731 • (813) 896-7171 Telecopier (813) 893-1940 Chester E. Bacheller Harvey A. Ford Douglas S.Jones Denise L. McCain Stephen O. Rushing Stephen C. Chumbris Raleigh W. Greene,Jr. Richard C. Langford Jackson L. Morris Peter R. Wallace Kirk S. Davis David T. Henniger George D. Lynn,Jr. Jeffrey S. O'Brien Louis Whitehead, III H. John Feldman William L.Johnson R. Donald Mastry Charles W. Ross John A. Yanchunis Writer's Direct Number: December 5, 1988 813 893-1982 City of Sebastian Post Office Box 780127 Sebastian, F't, 32978 Re: Dorothy R. McCain Cemetary Plots (7) Block 24, Lots 21, 25, 36, 37, 38, 39, 40 a/k/a Lot 1, Unit 1 O.B. Dear Sir: Please be advised that the record owner of the above-referenced lots and plots is deceased and that the cemetery plots and lots described above are currently the property of her Estate. The personal representative resentative of the Estate is Robert G. McCain, III, whose address is 8 Sunshine Blvd. , Deland, Florida 32724. The attorney for the Estate is Denise L. McCain, the undersigned, who can be reached at the address on the letterhead. Any notices with respect to the cemetery lots and plots should be sent to these addresses until otherwise notified. Mrs. McCain' s heirs are Robert G. McCain, III and Alto D. McCain. Robert G. McCain, III ' s address is stated above. Alto D. McCain ' s address is as follows: Post Office Box 1541, Marion, North Carolina 28752. Very truly yours, Denise L. McCain DLM: sb i ■I McCAIN, Dorothy see also Herndon UNIT 71. 0.P., Pln-s.k. 24, Lots 21, 2.11,, 25 36, 37, 3d, 39, 140 a/k/a Lot 1 ^ z-oF • .,-(3 r- J ` STALLINGS, UNIT 1 O.F., Flock 21,, Lot a/k/a Lot 1 • I WELLING UNIT 1 n.F., Flock 2) Lct a/k/a Lot 1 Flock 24 Lets 21, 2?, 23, 21A, 25 TJnit 1 0.P. 36, 37, 38, 39, 40 a/k/a Lot 1 Boyd, S.C., Welling, Std7Jings HER.NDON, Mrs. Sallie Deed # see also McCain UNIT 1 O.R., Flock 24, Lots 21, 22, 23, 2L!, 25 36, 37, 38, 39, 40 ,,/k/a Lot 1 —1-)0roVkN_\MQ r) fAt(- LC)/c90 ? O3 L • • . • il% 1 t V p r • J -�) ...."--•. .% • f o l r i • -- 1 c- c„ 141:1:at.(64-.........ss.l.pp - ,� I r ` • \ --S ' V D • 1114 ,..\ N. • j , . r i� ``' 1 , , . - _D r p - C`-' �.� u J :.1. 1 r�I, ` I - x ��L7- ......, ... cs.:. ••' l `� � ° 1 6p t �` -r , tD4 N ti q �_.. _._- . ......_ ,a t ^ ® 1, ,�y, a 1 hl �+ _ `N i S OD vi t • .. *"1 (-02 v. +vim t • 4 N ■ t V�M. 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