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Date of Burial � r � Time
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Name of Funeral Home ' " x.� r-
Authorized by " '` �� "
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SCUDIERI, George & Mae
385 No. U. S. #1, Micco (with Lavrich)
— daughter —
Block 38, Lots 9 and 10
Uni t 1 Addi tion `'
Deed # 417
Mae interred 10/IS/80 — Lot 10
� 2�rFj e S�u.�(.i.a� r �,�.-�.� �$'�7/S'�,
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Paid by CB��e�i Receipt No. . 2.Q8. , , . . . . . . �
& 209 ... Dated......Oct. Z6 Z980
...
List I'rice �. . .'.F.*350. 00** �Z�ximum :Vo. Burial spaces . . . 2 . , . , . .
Discount $. . , . . .'-. '
Total area in square feet ................
Net Paid $. . * * 350 . QQ * *. Monument
permitted . . . . F.1.a t . . . . . . . . . .
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_ f� S�- ,�� (Data above Yhis line for City R.ecord only)
Deed
George & Mae Scudier.
385 No, U.S.#I, Micc�
BZock 38, Lots_:, Un_
9��c7 ,
Mae interred 10/I8/8c
((Pd. by Louis Lavricl
(Deed # 4Z7 & 418
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Date of Burial � .� � � �� Time ,� �� ' -� �
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Authorized by '�
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STATE OF FLORIDA
PARTMENT OF HEALTH & REHABILITA : SERVICES
VITAL STATIS7ICS
APPLICATION FOR BURIAL—TRANSIT PERNiIT
� I, /�;
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A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased O F
GFORGE (NMN) SCUDIERI DEATN Aug. 5, 1986
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Micco Inst. g025 US 411
3. Name of Medicai (�Physician Address
Certifier Farhat Khawaja, M.D. ❑Medical Examiner 7754 Bay St., Sebastian, Fl.
4. Funerai Horrie/ Name Address
Direct Disposer Strunk Funeral Home, 734 N. Central Avenue., Sebastian, Fl.
5. Check a�'fhe medical cerufication has been compieted and signed. A completed certificate of death accompanies
Appro- this application.
priate b�! was contacted on . He/she verified that
Dox this death was from rrawral causes, that there was no accident nor oth�r extemal cause of death, and that
will complete and sign the medical certification of
cause of ciealh.
6. Funeral Director/
Dir ispo?,'Lr-�
B.
C
�
C(� was contacted on . He/she verified that
, Medical Examiner, will camplete and sign the
medical certificatior�. . ,
�ynature
C.'�-'L''t
Fla. Lic. No./Re,y. No.
�//
< C� ��
BURIAL—TRANSIT PERMIT
Date
. 5, 1986
1228-86-311
Permit No.
Permission is hereby granted to dispose ot this hody. �--
[] A five day extension of time for filiny the death certificate (exclusive of weekends) has been requested and
yranted. If it cannut be tiled within this time limit, a"Funeral Director/Direct Disposer Report" will be filed
with the Local Registrar of the County in which death occurred.
Reyistrar or
5ub-Reyistrar Si,ynatu
Date
Issued
. 5, 1986
AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA
Signature , Medical Examiner Date
or
Meciical Examiner, , yave authorization by telephone to
— � Funeral Director/Dfrect Disposer. Date
The Medical Examiner's approval rnust be obtained before disposal by any of the above methoda. A waiting period of 48 hours atter death
is reyuired for all cremations.
Method of Disposition:
� BURIAL ❑ STORAGE
� CREMATION [� OTHER (
5iynature of Swc�en--}
or Persorrin-Charge ).
CEMETERY OR CREMATORY
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Place of Disposition��A�a� /���i.��
Date of Disposition �" �" ��
afy
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This permit must be endorsed by the 5exton or persun-in-charye (or by the Fimeral DiretL6r/Direct Disposer when there is no Sexton)
anci returned within 10 days to the local County Health Department in the County where disposition occurred.
HRS Form 326, APR. 81
(replaces �.�revious editic�ns which may be used.)