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Home My WebLink About2-08-07a IJ pit 1 p 4 F6 off' r I - Name ' Unit { Block Lot Date of Mark -out f Date of Burial__ u Time .Name„Qf,Funeral Home, Authorized by t - _ 6. Funeral Director/ Sig r��ure� Fla. Lic. No. /Reg. No. Date Signed D!w&uZiHaQftr _j C_ BURIAL — TRANSIT PERMIT Permit No. 1228 -87 -333 Permission is hereby granted to dispose of this body. 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 with the Local Registrar of the County in which death oc- curred. ❑ No extension of time for filing he death certificate requested. R" G Date Date Certificate Sub - Registrar Signature Issued: 9!8/87_ Due: 9/15/87 C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature or Medical Examiner, The Medical Examiner's approval death is required for all cremations. Medical Examiner Date , gave authorization by telephone to Funeral Director /Direct Disposer. Date must be obtained before disposal by any of the above methods. A waiting period of 48 hours after D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition •� '� ``" '` ❑.1$URIAL ❑STORAGE Date of Disposition ❑ CREMATION ❑ OTHEA (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 County Health Department in the County where disposition occurred. HRS Form 326, May 86 (Replaces Apr 81 edition which may be used) (Stock Number: 5740- 000 - 0326 -2) STATE OF FLORIDA PARTMENT OF HEALTH & REHABILITAe SERVICES VITAL STATISTICS APPLICATION FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF ANNIE J. CONAWAY DEATH SEPT. 5 1987 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER VERO BEACH Inst. INDIAN RIVER MEMORIAL HOSPITAL 3. Name of Medical [`]'Physician Address Phone Number Certifier DONALD D GOLD M D ❑ Medical Examiner 2300 5TH AVENUE 567-711L- 4. Funeral Home/ Name Address Phone Number (Area Code) D"aLaLwawr STRUNK FUNERAL HOME 1623 NORTH CENTRAL AVENUE SEBASTIAN FL 305 589 1000 a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies 5. Check Appro- this application. priate JOANNE was contacted on 9/8/87 within 48 b Box 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 GOLD 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. Funeral Director/ Sig r��ure� Fla. Lic. No. /Reg. No. Date Signed D!w&uZiHaQftr _j C_ BURIAL — TRANSIT PERMIT Permit No. 1228 -87 -333 Permission is hereby granted to dispose of this body. 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 with the Local Registrar of the County in which death oc- curred. ❑ No extension of time for filing he death certificate requested. R" G Date Date Certificate Sub - Registrar Signature Issued: 9!8/87_ Due: 9/15/87 C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature or Medical Examiner, The Medical Examiner's approval death is required for all cremations. Medical Examiner Date , gave authorization by telephone to Funeral Director /Direct Disposer. Date must be obtained before disposal by any of the above methods. A waiting period of 48 hours after D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition •� '� ``" '` ❑.1$URIAL ❑STORAGE Date of Disposition ❑ CREMATION ❑ OTHEA (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 County Health Department in the County where disposition occurred. HRS Form 326, May 86 (Replaces Apr 81 edition which may be used) (Stock Number: 5740- 000 - 0326 -2) #166 1115179 DEED #381 #168 11116 Tian L. or Evelyn J. Pate Paid by General Receipt No. ...#.16.9..121&. Dated .............................. P. O, Box 743 (10th Street) List Price $20a.Q0......... Maximum No. Burial spaces 2 Sebastian, F1 32958 Discount $.... - ............ Total area in square feet ............. Net Paid $200.00. _ ....... Monument permitted ...........flat ..... 0 LOTS 7 & 8 BLK *9 UNIT #2 R6rR atCh (Data above this line for City Record only) CCr"ZAWAY, CARL GRADY & ANNIE LOTS 8 & 8 BLK. UNIT 2 Van or Evelyn Pate P.O.Box 743 Sebastian, F1. Carl Grady Conaway interred 12/3/83 - Lot 8 Annie Conaway interred 9/8/87 - Lot 7 211 GEM Index:RECORD # NEWCEN Record:761 Last Name Address i Address 2 City Deed # Unit # Number Number Number Number City of Sebastian, FL — Cemetery Lots PATE First Name UAN L. & EUELYN J. P.O.BOX 743 SEBASTIAN 381 Date 2— Block # 7 Interred 8 Interred Interred Interred <F >wrd <B >ack <E Thursday, Jan 20, 2005 10:13 AM State FL 12 -06 -79 Amount 8 CONAWAY, ANNIE CONAWAY, CARL GRADY Zip $200 32978— Dte Interred 09 -08 -87 Dte Interred 12 -03 -83 Dte Interred Dte Interred U <R >e— search <L >abel <T >aa <Esc>