HomeMy WebLinkAbout1-35-36 1 , ,
w
! i
i
eLK-4 35- 1 i iii • 74
E rrNI. PnmPVRE; Pe orr ! ! 1 ;sib, ilt
C. P001 E2v's Toll rr 4' ' i
w, l r• --L5,- 2: 1,.) if le 8.7' ;) I
n Soln f I I`
pf 2 R.R Trio X95 bEti .R F D//N ' r f l q 1 ae+
e.. ✓ v w. E20, P,Tx4u4a+ °sE ✓ ' 1 I
i
E..t/ N.,o L F E ..,**a+r P nl. ,,
S a1.p
•i 4 ' e S�.I I
5 �_ :r s ,i I o, i
Soso �- �
• „..0.4 r„1 N
,CE .g T,� o� .I A2 ►� �� 7,1'111-1.... ,�30 1
w. �erlflR.l.f :T
Josepµ.G n+uy. [. i •
3,:24
a3 `8 ,,,n ,!/ II j 1
Js
,-T£v E, i
; ' 1
•
. I c1AR H j P., 2oi;:ij
.1'1 . 1 ,
_ ; UNIT ONE iTiff
•
7r>✓, , G.,r...:•.■c. .z-is-73 Mrs. Clara Brodsky ✓A
Paid by General Receipt No. /.3. t,,,,, March 14,. 1973 Box 522, Sebastian
Dated Res: Main St., Micco p
200.00 04
List Price �T� Maximum No, Burial 2
�• S a.p, °�—�: spaces Lots 35 & 36, blk 35, unit 1
Total area in square feet
Net Paid (. 4 Flat /
./� s�,
�.Pe.@ Monument permitted
y j +
�o e,� �� o-n °v� oI 1� <:
ti (Data above this line for City Record only) r/�-;r ``V
',IiflT Iii I)ii{ r•
DEPARTMENT OF HEALTH AND REHABILITAT-IVE: SERVICES %%% 5-4x 3
• VITAL STATISTIC'
�C L
�`//
APPLICATION FOR BURIAL-T SIT PERMIT
NAME OF First Middle Last DATE Month Day Year
DECEASED OF CLARA BRODSKY DEATH Aug. 8, 1980
PLACE OF DEATH CITY, TOWN, OR LOCATION NAME OF (If not in hospital, give street address)
count
TnY d ian River Sebastian IHNOTUe,b s
tian River Med. Ctr.
Attending Physician N (Name of Medical Certifier) (Address)
Medical Examiners Ii Muhammad Siddiqui , M.D. 937 Barefoot Bay, Barefoot Bay, Fla.
Funeral (Name) (Address)
Home Floyd/Strunk Funeral Home. , 2405 14th Avenue. , Vero Beach, Florida 32960
Check A ❑ A completed certificate of death accompanies this application.
One
B Dr. Siddiqui was contacted on __ August 11 . ,19 80 .
He has assured me that this death was from natural causes and that he will complete and sign the medical
certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medical Examiners jurisdiction.
The body was released to me by
on ,19
(Si. at ) ...--N )Fla. Lic. No.) (Date Signed)
Funeral "
Direct , • _ 1382 August 1 1 , 1980
BURIAL TRANSIT PERMIT Neormit 130-721
Permission is hereby granted to dispose of this body by burial, transportation out of state, storage or cremation. For cremation a
waiting period of 48 hours after death must be observed and the Medical Examiner's approval must also be obtained.
P9(A five day extension of time for filing the death certificate has been requested and granted.
Signature of / �--• �� Date
1_,fr Registrar !/ ��) (may,_./ Issued August 11 , 1980
CEMETERY OR CREMATORY
Method of Disposition Date of
.!it c,-6 C-J_ - . /y:C C:;
' , BURIAL Disposition
CREMATION
❑ STORAGE Place of 1 ,i//r
H OTHER(Specify) Disposition •.:---••'__ /;zr .; �� n.�, � . _ . : �_ /� ci./
Signature of-Sexton
Person in Charge �_ /
This permit must be endorsed by the sext n or person in charge (or by the funeral director when there is no sexton) and returned
within 10 days to the local county health department.
HRS Form 326 (1/77)
s s
ilk
11513
February 3, 1981
FOR APPROVAL
CITY OF SEBASTIAN
SEBASTIAN CEMETERY
Sizes 24" x 12" x 4" TO BE SET FLUSH WITH THE GROUND
AND CONCRETE PLACED UNDERNEATH IT.
24s"
n
Q.:. L_Prg iq IBleDAS1 /12
1B9 — ( � iEo 1
4"
4" thick
Bik. 35 Lot 35 & 36
APPROVED:
2.1f1 g
DATE: