HomeMy WebLinkAbout1-35-30 . -,„iP 4."...i c,r,...,,/,,,,... 1 •
,._.1,0 No.
.9
---'- _.....4.--,._ , ___ .._,..„. . .44.......e ......-4.,-.4-----
.,.._ s' '' -SONIA-114i, Flu.,"=8: -.2 '-'" '''', 1.9'' -i --- --.
•
//1 b,/,":,' ,. .,,,....-e. -----'
!
„.....„ , I
!RECEIVED OF ''''''''..6'-i--"--c--('""'-''' 4/' l'4'.' ',-... /
: ,..".:"'-; ---, , ••,. - • 'i
. .•-_ 4, V''' ' ;
$ (,--",-,„„........,• , „"or-e-e,.- ,--,.-e.:...'4,x, -„,k ,..., , „;,„„)
-•,•‘ .,..,,,,, _ ^ - • ' " ' -
-'," - ' Dollars $
'.7,.., /..-.■-k !
\-
,.,
For-Th s'*-- ......- ----. - , 4, , -r.0-_, , ... „
- ‘d-V--- .
!
._ .
„t.....,.)
CITY OF SEBASTIAN
1
Amount Paid
•
—,..,
I
1 /-,:_ --, . '1'/14/.4-
BY .* - ----'--..........
1
-- +#.00.1104411141NIPOODININIIIIIIHMINIMIMMININNIN•11111•11111WINIIIINHINNIIINIONIIIINIMNIIHNIONINMENININNOIMINININSIMII1441■••••■•••■•■•410+
----____
" --- .
Name ie g E iv 77.
•
Unit
,.,
Block 35
Lot 3 -6)
Date of Mark-out ci? /5- /9a
Date of Burial . /8 79 a , Time /,
■ t)o9. tyl
.._ .
Name of Funeral Home
. ,
. .
Authorized by-
I
l >, -56'
(S�_��77 State of Florida,Department ikalth and Rehabilitative Services,Vital Star A`-3 .3
TT77 APPLICATION FOR BURIAL — TRANSIT PERMIT la
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
Rhea Thelma Wear DEATH 02/05/92
2. Place of Death City,Town or Location Name of (If neither,give street address)
County Hosp. or
Osceola St. Cloud Inst. Osceola Health Care Center
3. Name of Medical I Medical Examiner Address Phone Number
Certifier I 1320 N. Main Street
Esdras Filart, M.D. ',Physician Kissimmee, Florida 3474 (407)846-6669
4. Name of Funeral Home/ Address Fla.Lic.No./Reg.No. Phone Number(Area Code)
Direct Disposer 1623 North Central Avenue
Strunk Funeral Homes, P.A. Sebastian, Fl 32958 1228 (407)562-2325
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
pr iate
Box b ❑X Rose was contacted on 02/05/92within 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 —Esdras Filart, 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 Cemetery In state cemetery/ Removal
Final Disposition: crematory -nam /c•��y: Indian River Ti 1 from state 1 Donation
' 7. Funeral Director/ atuFe /f F E.No./Reg-Ns. Date Signed
A3ifect-Diser ' 1672 02/05/92
B BURIAL — TRANSIT PERMIT
Permit No. _1228-92-0067
Permission is hereby granted to dispose of this body.
❑ 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 fili . he death certificate reques -I.
Registrar or Date a' Date Certifi e
Subregistrar Signature ■_ ll∎ ` / - / '1.ter Issued: £ 7+ Due: --��- 9�
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 Sebas t a i n Cemetery
[iii BURIAL ❑ STORAGE Date of Disposition Feburary 8. 1992
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton ) �/
or Person-in-Charge) /l <p 9 "
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)
I
r r-
_ : , ,; 1 -
3 35- i I 1 .1 :`
w I ; +++ ;
1
{ ,
. / 'm a 3 -& 9 s' -6- G 3 B :+ 9 ; 1.-1/i)sit VA'
Atic�oT,. � � ;SH, �� ' 13t.
rfw'1• owrah RL-1f„ PTl'Ef l try i It
� C. ✓ " ic, ti,,iSiNE2YIS o f 6, 1 • I j
7 M Arrt< I i112.; / i
I
n! 1D .A02, ! t . I ors
. • , ia1'X_ ill 1q`i2. sbc1, 1412/ 19�� <m► ∎ ` 19`113 2 161 ' !
I)1 ) RILE, Tli c n•1 b E{, R F 2v aos ✓ , • i , •
; vT
1(1'11 S o 1-D '41• ' t1 � .r ' :'� . -I I, 5 ..b 0 1. D *�
1( 5c. p ! 'Y
5 v - j I
29 -12'30'
z 2'2- �x 3 rR y,h or C/ `"• av c ' 1 f>i s : yr q l.T �
k E ,6 t ° Tay Hotz 7
E,
, w.. ) 3-'9 5 eP°1 CI.y.d),. . ,5 5 ^ • i ,G,,,' i j: -- I
31 3.3 .•1 AS 37 3S 1 0 . i
51f.rc. ) ou s 1 i ,
SiCltiRi3. I r i
� 7 1r,PC!,N,A 13 E.,1-.614, / q /9N,rf1. I i 1� o � =:i
fi• i L� •rte '� ; i►4''
Q
E.. , n : 3 • iO r.1G 1 /� 5n,..fi1! . ! s1,L '
I UNIT ONE i ( j
•
. 1 1 I . i
'
Ck eorgia L.Allen #521 DEED #216 ,/'
Paid by General Receipt No. Dated, Sept 9, 1973
WEAR, Walter E.&Rhea ` .7;
List Price $..$15g.. Maximum No. Burial spaces ..2 P. 0. Box 83
Disc nt $ Marie Total area in square feet
Roseland, Fla
Net aid $..$15D•D0. Monument permitted ...f la t Blk 35, Lots 29 & 30 Unit #1
(Data above this line for City Record only) ✓