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DEED #467
CEMETERY
Paid by "Receipt No. . 27 ?....... .... Dated ....... August 12, 1981
" Elwood F. and /or Mary Jo Shepard
Last Price ...... Maximum No. Burial spaces ..6 ........ Mary Joanne and /or Richard M. Shep
* * * * * * * * * * * . Total area in are feet .�....�.. .
(Sister and Brother)
Discount � ................. �N 321 S. W. Pine Street
Net Paid $..$.600.00...... Monument permitted ..flat ............. Sebastian, Florida 32958
& R Issued with Deed (Data above this line for City Record only) UNIT 2addn, BIk.44, Lots 3,4,5,6,.
IT
State of Florida, Depa of Health and Rehabilitative Services, Vit�atistics
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APPLIN FOR BURIAL — TRANSIT PERMIT
Z/ a'e
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased t OF
Mary Jo Shepard DEATH July 8, 1997
2. Place of Death City, Town or Location Name of (If neither, give street address)
County , Hosp. or
Indian River Sebastian Inst. 321 Pine Street
3. Name of Medical Medical Examiner Address Phone Number
Certifier
Alec Lui, M. D. Physician 13845 U.S. Hi h av #1 Sebastian, FI 561- 589 -9071
4. Name of Funeral Home/ Address Fla. Lic. No. /Reg. No. Phone Number (Area Code)
Direct Disposer 1623 North Central Ave.
Strunk Funeral Home Sebastian, FI 32958 1228 561 -589 -1000
5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box b ® Judith
was contacted on 7 / 8 / 97 within 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 Dr. Lui 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: crem y - name /county: Indian River F1 from state Donation
7. Funeral Director/ r F.E. No. /Reg. No. Date Signed
iWeet- Dicpaccc. 7/8/97
B. BURIAL — TRANSIT PERMIT Permit No. 1228 -97 -0304
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 filing the death certificate 'requested.
4_o? to "r — Date Date Certific
Subregistrar Signature Issued:. i Due: i% f 9 7
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 _ - - /s 4 el,",11�2�L�j/
S BURIAL ❑ STORAGE Date of Disposition . Y //, LQ r /
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge)
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)
Note to File — Unit 2, Block 44, Lots 3, 4, 5, 6, 7 & 8
Date: 7/14/04
On this date, Kip Kelso received a phone call from Joanne Shepard, who is the daughter
of Elwood F. and Mary Jo Shepard. She was concerned because she knew that Lot #4
was purchased by her parents for the wife of her brother, Richard M. Shepard. At the
time Richard was married to Karen. Richard and Karen divorced approximately 20
years ago and Richard has remarried a girl named Gayle.
Kip asked that I look up the information and call Joanne Shepard at 589 -4975 and let her
know the status of the lots. After reviewing the information it was determined that the
names appearing on Deed #467 are Elwood F., Mary Jo, Mary Joanne and Richard
Shepard.
I advised Joanne Shepard of the information and also let her know that the named Deed
holders would be the ones to make the decision as to who is interred in the lots. She was
satisfied with this information.
Ann Rousseau) 4 I