HomeMy WebLinkAbout1-24-34 •
0-
1 47"."."."""--77------‘JH . 'v_ O 0 :r �` C `\\
iG W 0 T /
Ls
w
O
cv -
•'-- C.' r \ 0 �, ,
/S
} G' •
r _
L o
�7 Po?.-- _, . -% s.....tk..
Ck
�: s it
) -1
_'rJ h
—. /IC O` U1 ` r
I -
e,,,,,,,s„ -:••-,,
Ne
y . 1,7 a c,,
N.
t
Is C, . °' .J J r
•'d � °. ..,_
�r 0
la. :.
•
t. '.. ,o . ' , -. t..,...,, 1 I 05® k :,- s,<- . ''/ ok '
Co I
Qi
.m (a /2.\®
,-.-..z \ '-"..A..C.I 173
•
v:. o • � `YG s'— /f.5)4.* � �.v U tr .h - wr. (s,. MAarA
_ MRS.Purt.bck s FArhE.)
1 C 7.,
ra
c G)
i. (11. ti, ( t, (;) iv 7‘ P,, -1 ,..,
o
fri NI W
�
Or yr►1
.....1 -glirni 1/1
I
- State of Florida • Department of Health and Rehabilitative Services • Division of Health
o � � 13 a y Burial Permit No..�4��(t-5
a
H .6 BURIAL-TRANSIT PERMIT
°/ Full name of deceased Thomas Mitchell McPherson, Sr.
D
° Place of death )izQ Sebastian Indian River
1— Florida
H (City) (County)
Date of death May 24 19 74 Color W Sex m Age 81
Method of disposal Burial Sebastian Cemetery
. Gl (Whether burial, cremation, transportation, storage, etc.) (Cemetery or Crematory)
pc
> County Indian 1 ive r State Florida
c
a A certificate of d�atli having been filed as required by the laws of this State, permission is hereby given
E to David Hincemon License No 1672
o (!Funeral Director or person acting as such)
u to dispose of body of said deceased as above stated.
Q 5-28-74 t_ y g N Date issued Signatur ....1 �1 2,.—l`� y -a `L
5 / (Registrar
EMETEFLY R CREMATORY AUTHORITY S ILL UT SPACE) BELO ' -
Body was c --UZL�/ on lit ''. 6 192.- in
f.
Late w cremated, buried', tore etc.) ;' (Cemetery or 'remat )
D. Placed —�c�
— 511 Signature...
M 4• ax.Lon._ns person in charge)
Sv.s.x640
F- This permit must be endorsed by the Sexton (or by the Funeral Director where there is no sexton) and re-
turned within 10 days to the Registrar of the district in which the burial takes place.