Vallee, John State of Florida • Department of Health and Rehabilitative Services • Division►y pf Health
Burial Permit No.L+1 -Th
BU AL—TRpsISIT PERMIT
Full name of dec ed[�
Place of death x0= �Cy ! Florida
(C unty: :....97L(
C e.
.. ,�}sa __P-47v
0 sl (kr burial, cremation traz tattion, storage, e ) (Cemet or Crematory)
County J �J.44 X Iv State
certificate f deat ha i)v' been filed as r quired by the laws o this Sta ermission is hereby given
� �.�to `P • - cense No 1-..0.....1-. .
(Funeral D ector or person acts as such)
to dispose of bo,Inpf said dec sed as abov .�, •stated. ,^ % ...a-�
Date issued t t-.•L-y-7•••-•- Signature
(Registrar)
nCElyIE7Rf OR CREMATORY AUTHORITY SHALL FT OUT SPA/CE� BE TT
Body was--31 -5 on 0�A�C. th2.. 19:1(f in �� -:.. sue ) %�.'►:4?�..Lfi,64.
��{{ (State wh ti'er cremated, buried, tored, etc.) (Cemet or Crematory)
Place lam` ' r, t-- `' 'I- V-2-T i Signature.. '
Peru (t c . .vt g .L �?Y +t..4*5 r pens(Sexton o in charge)
V.S.#640
J
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.