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HomeMy WebLinkAbout1-31-06 clock 31 Lots Unit 1 0.B. a/k/a. IThq: Lot 3 Tuten, Mrs. J.D. Fel_lesmere Name f' -11 v1[dQ (MI en ) C4/e/bA) Unit Block 3 / Lot (!J Date of Mark-out 5/06 , / 41/00 Time v�. 4U �0 Date of Burial + Name of Funeral Home l 66 $ Ftth tra / /4 Mme' i Authorized by Rec. Remains 6 FLORIDA DEPARTMENT OF Stat Florida, Department of Health,Vital S�tics 5/6/00 HEALT APPLICATION FOR BURIAL-TRANSIT PE T 4 / A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased Alvilda Mamie Carlton Death May 6, 2000 2. Place of Death City,Town or Location Name of (If neither,give street address) County Hosp.or Taylor Perry Inst. Doctors Memorial Hospital 3. Name of Medical Address Phone Number Certifier Dr. Ghulam Mohammed 409 E. Ash St. nMedicalExaminer [Physician Perry, Florida 32347 850-584-0600 4. Name of Funeral Home/Direct Disposal Address Fla. Lic.No./Reg.No. Phone No.(Area Code) Establishment 201 West Main Street Beggs Funeral Home Perry, Florida 32347 2420 850-838-2929 5. Check a. ❑ The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. © Sharon was contacted on 5/8/00 He/she verified that this death was from natural causes,that there was no accident nor other external cause of death, and that Dr. Mohammed 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 me • I certifi'atio. of -use of death within 72 hours. 6. Funeral Director/ ` Sig ,=tu F.E. No./Reg.No. Date Signed/ Direct Disposer w,%�-p AI r• 3549 J e 0 '► V.PrG B. BURIAL -TRANSIT PERMIT Permission is here: • anted to dispose of this body. Permit No.2 4 2 0-2 O O 0-3 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. ONo extension of time for filin• - death certificate has been requested. Registrar or Date Date Certificate Subregistrar Si• - - Issued: 3 Due:Amdio, 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 Sebastian Cemetery in BURIAL El STORAGE Date of Disposition May 12, 2 0 0 0 fCREMATION OTHER(Specify) Signature of Sexton or Person-in-Charge J} ',G.Le, �O 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. Distribution: White: Cemetery or Crematory Dhl 326,8/97(Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number 5740-000-0326-2) Pink Local Registrar (o• o ‹? S PLO OP PELICAN CSC City of Sebastian 1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958 TELEPHONE(407) 589-5330 0 FAX(407) 589-5570 August 15, 1994 Mrs. Alvilda Carlton P.O. Box 183 Fellsmere, Florida 32948 Dear Mrs. Carlton: In response to your telephone call this morning, a search of our records reveal that Cemetery Lots 6 and 7, Block 31, Unit 1 were purcharsed by Alvilda M. Tuten, and that John D. Tuten was interred in Lot 7 in 1960. If you have any questions, please give us a call. Sincerely, Kathryn M. 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