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Deed 201
Paid by General Receipt No.
149 (cash) Dated April 20, 1973 mr. James E. Reynolds
2 and Anna S.
List Price $
150.00 Maximum No. Burial spaces
Total area in square feet Blk 35, Unit #1
Discount flat lots 37 & 38
Net Paid $..15 0••MI••-•••• Monument permitted
P. 0. Box 421 H, Sebastian
(Data above this line for.City Record only) (Indian Kiver Dr. near Judah's)
1
/STATE OF FLORIDA /3
(
1111,ARTMENT OF HEALTH & REHABILITA SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL—TRANSIT PERMIT Z
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
ANNA STONE REYNOLDS DEATH May 19, 1986 •
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Orange Orlando Inst. Florida Hospital Orlando
3. Name of Medical ® Physician Address
Certifier Charles R. Curry, Jr.M.D. ❑Medical Examiner 615 E. Princeton Street,Orlando,Florida
4. Funeral Home/ Name Address
Direct Disposer Haisley-Hobbs Funeral Home, 3015 Okeechobee Road,Fort Pierce,Florida 33450
5. Check a The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate b ® Charles R. Curry, Jr. M.D. was contacted on 5-20-86 . He/she verified that
Box this death was from natural causes, that there was no accident nor other external cause of death, and that
he will complete and sign the medical certification of
cause of death.
c LJ was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medical certification.
6. Funeral Director/ Signature Fla. Lic. No./Reg. No. Date Signed
Direct Disposer
2056 May 20, 1986
B. BURIAL—TRANSIT PERMIT 904-1814-86
Permit No..
Permission is hereby granted to dispose of this body.
rT! A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and
granted. If it cannot be filed within this time limit, a "Funeral Director/Direct Disposer Report" will be filed
wit e Local Registrar of the Coun y in which death occurred.
Registrar or J-� , Date
Sub-Registrar Signature /t f� fff///��� Issued May 20, 1986
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
Signature , Medical Examiner Date •
or yv
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
BURIAL ID STORAGE Date of Disposition
CREMATION J OTHER (Specify)
Signature of Sexton ) e _-1r or Person-in-Charge ) (Sell/t.-
�
Deborah C. Krages - City Clerk
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.
HRS Form 326, APR. 81
(replaces previous editions which may he used.)