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HomeMy WebLinkAbout1-30-19 "-D -1`‘ FAIR, Mrs. Charles (Interred) eed /71J FAIR, Charles box Nil ro eye cta,_ UNIT 1, Block 30, Lots 19, 20 1974_, iLn eirTiCak(4,\ Ck-64A-°6611gi91 — le I 16161 Lts4 g Name /7- Unit • Block Lot Date of Mark-out Date of Burial Time to/ Name of Funeral Home 57'A?arl) Authorized by Deed t/1,.. - 171 Paid by General Receipt No. `- Dated - 2!---ries E. Tair - 7,3* ac Ir71 (livss i List Price $ a--•' Maximum No. Burial spaces 2 Y Discount $t -5")167-7-) Total area in square feet , Net Paid Monument permitted 2 F-/2 (Data above this line for City Record only) 7-- - - - -- - - -....miiiiiiiiiimp 4.OrliMIIPHIND*11111•1110•110•11111•1111114.0114■1111•011•1111■41104111■•■••11101111141111N41111•41111W1111N•111•4110•111N4111■• 11•1•0114111WHINI1110111111*. i CITY OF SEBASTIAN No. o2 (/ • Phone 589-5330 Sebastian, Fla.,329582:2-. - LL19 7( i c 1 ;RECEIVED OF 6=X c ., ----V -V c et---t C ,J , a -A, ! 01= 1li' (....C,.......,c_ )1(_-,.. (.. ... ,...(2—t- ,Q, _, ,c,--e:. .e ei--, .. Dollars $ /5?-) ------ , !For f ir / Pr' )-41 ,die.,,3 e"/ V.ri,,,1„ . / $ Li eti, .1 i Amount Paid $ /-3 0, — CITY OF SEBASTIAN ‘---c.-- ',----41/1-6-t- iBalance Due $.; ,_..— By 4,........................................................................‘................................................. __ _ 4 /9, _^y; FRE 7 State of Florida, Depart of Health and Rehabilitative Services, Vitastistics i [7 L 7:3 APPLICA FOR BURIAL — TRANSIT PERMIT A. (Type or Print) /j / 1. Name of First Middle Last DATE Month Day Year Deceased Charles F. Fair DEATH 10/03/1996 2. Place of Death City, Town or Location Name of (If neither,give street address) County Hosp. or Indian River Vero Beach Inst. Indian River Memorial Hospital 3. Name of Medical I Medical Examiner Address Phone Number Certifier 7744 Bay Street Noor M. Merchant, M.D. Physician Sebastian, Florida 34958 (561)589-0879 4. Name of Funeral Home/ Address Fla. Lic. No./Reg.No. Phone Number(Area Code) Direct Disposer 916 17th Street Strunk Funeral Homes, P.A. Vero Beach, Fl 32960 130 (407)562-2325 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b C Wcndy was contacted on 10/03/199'9ithin 72 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 Nnnr M. Merchant, M.D. 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. Place of Sebastian Cep - :ry f In state ce etery/ Removal Final Disposition: lid cremator '-name/county: Indian River p from state in Donation 7. Funeral Director/ Sign..e.re F.E. No./Reg.No. Date Signed Direct Disposer A A.' B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No 0130-96-0454 ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit.If the certificate cannot be filed within this extended time limit,a"Funeral Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for fil' e death certificate requested. Registrar or Date 1©_3-�Cp Date Certificate Subregistrar Signature ` �� Issued: Due: 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 Methods of Disposition: Place of Disposition 5/-="x-5/4 S/i Ail( C7 iVtie f S BURIAL ❑ STORAGE Date of Disposition /0/51F(�. ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person-in-Charge) 7(. 2,1_ - 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326.Feb 89(Replaces Oct 87 edition which may be used) (Stock Number:5740-000-0326-2) L I 2 N, I� 7 !i.-«,-.- -_---^rte-- C_ T - 1-• " o`�- %� - -- i f ^ � q 1 • _e t� _I-T.....i . i . R ' 7C n-9 c-1 .. (. ,ti J L d �*t 1-) Q v q` i . \ \ ` Q 14/ b I 4' \ o �? �I •�' Y w,c \0 r "' \� �� • -t - cry ` z �. a i _�`= - � N \ r tIZ y4 � OJl ^ �� 3 yL 3 n ry ' • L i 1` z .....„ % g ',1, V V LLB. 1- : y 0 C♦ i�- V :s .ti of _q"t °� w wp• Q04a/�[y,�7/a�agh'nry 0i/off P.✓L'-et.,-/ i• -