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CHANGE OF DEED Replaces Deed ;59,dated 1/7/6 CURRENT DEED - x{200 V
New deed dated..,.... 5/15/73
Paid by General Receipt No. Dated {deceased)
�rg. A ie H. Hunter
%List Price $... .. Maximum` No. Burial spaces 4 BOX 125 (Hickory St)
Total area in square feet ............ Fellsmere, Fla ,
Discount $ Blk 28, Lots it-i-51-15–,-7
•lN*et Paid $...stke..or.iginal Monument permitted fla.t....,, Unit 1 (part" of Vickers)
deed :. /.1. c'1G S G, 7 r
(Data above this line for City Record only) '~
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Date of Burial 0 /' S Time /c2- : C f
Name of Funeral Home 13 i O W N LE y ty 1 A >( kia & 1-1,_
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SIA11 Of- FLU1iIDA �?
OARTMENT OF HEAL1H & REHABILITA• SERVICES r6J
VITAL STATISTICS
APPLICATION FOR BURIAL—TRANSIT PERMIT (/..--/:-=
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased James Hampton Hunter OF June 18, 1986
DEATH
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Indian River Sebastian Hosp. or Humana Hospital, Sebastian
Inst.
3. Nance of Medical TTPhysician Address
Certifier Farhat Khawa ja, M.D. ❑Medical Examiner 7554 Bay St. Sebastian, Florida 32958
w «4r...Fu,neral-klom40. __,.. Narne Address
Direct Disposer Brownlie & Maxwell Funeral Home 1010 E. Palmetto Ave, -Me rbourne; ri"tfia12,01'
5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
Box1e b ja' Ofiice was contacted on 6/20/86He/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
ause of death.
r' c/) ./ was contacted on . He/she verified that
, — , Medical Examiner, will complete and sign the
"-'i medical certification.
A. - j►G4 596 June 20, 1986
6. Funeral Director/ Signature Fla. Lic. No./Reg. No. Date Signed
Direct Disposer
B. BURIAL—TRANSIT PERMIT
Permit No. 496C97S
Permission is hereby granted to dispose of this body.
E A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and
granted. If it c n of be file( within this time limit, a "Funeral Director/Direct Disposer Report" will be filed
with the L gistrar of o ty in which death occurred.
Registrar or l . �� Date
Sub-Registrar Signature— — __ Issued June 20, 1986
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
y
!' Method of Disposition: Place of Disposition Sebastian Cemetery, Sebastian
Florida
BURIAL 0 STORAGE Date of Disposition
0 CREMATION 0 OTHER (Specify) (.;)/Signature of Sexton 1 dek2 C(./t- C ,,.' 40 – (le Lem
or Person-in-Charge ) — — , 10 — —
L
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 disposition occurred.
HRS Form 326, APR. 81
(replaces previous editions which may be used.)