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HomeMy WebLinkAbout1-30-12 WILLIAMS, Ned Deed #155 rb WILLIAMS, Mrs. Ned L. `v.. WILLIAMS, Lyle (Interred) UNIT 1, Block 30, Lots 12, 13, 14 I /7L,/,{f,le_ 3:jd-de - AL:62 - c_ra--; 76?)' \,_" ,,,, / ,� - X76 e / ` , 1 r L � L DEED #155 L Paid by General ReceiptsNoS. 147,148,150Dated 12/7&9/70 Ned L. Williams 2735 52nd Ave., List Price $ *600.00* Maximum No. Burial spaces 3 P.0. 1073 Discount $ - Total area in square feet Vero Beach, Fla. Net Paid $ *500.00* Monument permitted flat Lots 12, 13, 14 (Lyle-son) Block 30/� (Data above this line for City Record only) Unit #1 1 Name Al E 1. k k 'tp LI-(4 t e3 Unit Block Lot Date of Mark-out 7-7 e*. / ,,,I v fi r Date of Burial -5I .1 /L i Time {." }" t " Name of Funeral Home. Vii" ' ?4e Authorized by FLORIDA DEPARTMENT OF ` HEALT St Florida, Department of Health,Vital*tics A PLICATION FOR BURIAL-TRANSIT PER101IT A. (TYPE) / 1. Name of First Middle Last Date Month Day Year Deceased of Ned Lee Williams Death 5-24-2000 2. Place of Death City,Town or Location Name of (If neither,give street address) County Hosp.or Indian River Vero Beach Inst. 2735 52nd Avenue 3. Name of Medical Address Phone Number Certifier Gu R. Ulrich, M.D. 1265 36th Street I Medical Examiner nPhysician Vero Beach, FL 32960_ (561) 567-5181 4. Name of Funeral Home/Direct Disposal Address Fla.Lic.No./Reg.No. Phone No.(Area Code) Establishment 916 17th Street Strunk Funeral Home Vero Beach, FL 32960 0130 (561) 562-2325 5. Check a. El The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ® Kim was contacted on 5/24/2000 He/she verified that this death was from natural causes,that there was no accident nor other external cause of death, and that Dr. Ulrich will complete and sign the medical certification of cause of death within 72 hours. c. ❑ was contacted on He/she verified that ,Medical Examiner,will complete and sign the medical certifcatio cause of death within 72 hours. 6. Funeral Director/ F.E. No./Reg. No. Date Signed Direct Disposer 1pl� 2423 c5-Q5 a 1p© B. BURIAL-TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 0130-00-0255 0 A five(5)day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. No extension of tim for filing the death certificate ha- •-- equested. Registrar or Date Date Certificate Subregistrar Signature • ^ _ .. / •'�� Issued: --D5_,46.61,0 Due: .5-- C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date 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 Method of Disposition: Place of Disposition 4-L.�.�l eo„,,y/4-t NBURIAL :STORAGE Date of Disposition `°�` a.1 t a a o c� CREMATION ['OTHER(Specify) Signature of Sexton or Person-in-Charge •,/ .6.-/..;,.. S (' This permit must be endorsed bye 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. Distribution: white' Cemetery or Crematory DH 326,8/97(Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink Local Registrar k. , 11 le.3 _ , n 1 ^ R lb t Le))rq ■- 'Pri 'r ''f-- w, \ 0- — 9 - `•� r c- F,Col) 6 e... T `� y, z ail- (� k 1 t., 4 3 a ,-t -�5 , `moo f 'J \' \\l 2 4 p S n 7-fj R i� 1 ,..76 -b -1 L� ` L �� r 0. n -d 1 v _ �' COQ •� `� s. -c--.._.ts''':"'s>, A. . z �d t- Z 71.-1.4 T o 1 -� a ON - 1t C•' Z R lbw QD li ct S- i j {-i rt° � � . f R, • 1 _ . . 1 v _o__ ___-;OR „i 471 N r l \ -' Cs a if --__. 1 11• --, -___ .-.•--_- ....._ - X11 . S ,_________ . , lnffillMr N ,_ 'ROI 1 111111. INIIII ,. , . I' !!k1 , _ .,.; .. • :_-_ .1 -7',. ce.\.. . _Ng. ._ 4; , 0 (k, t xt \ ‘,.\‘ i w , t.1 * S '1 C k 1 u- \ c = \ , -. - ' ,-,._ 4:71:::: il .,1 .\ j. , L21__ \ _____ \..-i- (41. ,,, ,...;, ,,,, W __ t\r: \- , _ \ ,.. , '11110111M1 CV 4,4 I a 1 '/i _ ,., _ ... - .. .. . .