Hall, Harry FLORIDA STATE BOARD OF HEALTH
Burial Permit No
BU IAL-TRAN IT PERMIT
r Full name of deceased 3
1 p
r Place of death 1Q._ C(. n clii..4. 1 . Florida
� AA City)/- �( 9 l(County)
• Date of death Y\,11.. C 19: i. t1`„1 Sex.... .... A e_. l
r
• Method of disposal 1.. ..
i (Whether burial, cremation, transportation, storag a .) y (Ce ery or Cre Ty)
•
County -- GS. n..D.AA State •f?J .7
i 'ficate o deat vingpb n fil s required by the laws of this State, permission is hereby given
•L to J i��4�License No I:33..ti
i Fun/ al Director or p rse on ac ng as such)
to dispose of body of sal deceaasseedi above stated. , —. '�)
Date issued 3-- / — / l Signature.... ._. i1L�-t
i (Registrar)
EMETERY Cp. CR TORY AUTHORITYS FILL OUT SPACE BELOW
Body was -t"4 6 ` _6 / n /,4 e 4� �7 19,17 in. _ 1( ;,-)r r %( ° ELT ly
(State whether creme ed,buried,stored, etc.) (Ce etery-/or re y)
Place i�:.L ' /)• L <� : ' /-.. 1Signature C _-
f / (Seaton or person in charge)
! V.S. # 241
• This permit must be endorsed by the Sexton (or by the Funeral Director where there is no sexton) and re-
turned within 10 days to the Registrar of the district in which the burial takes place.