Aronson, Barney 'f
S1Att OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL-TRANSIT PERMIT
NAME OF First Middle Last DATE Month Day Year
DECEASED
(Type or print) Barney Aronson DEATH December 18, 1976
PLACE OF DEATH CITY, TOWN,OR LOCATION NAME OF (If not in hospital,give street address)
COUNTY HBroward Hollywood INSTITUTION MemorialSPITAL Memorial Hospital, Hollywood
Attending Physician [X (Name of Medical Certifier) (Address)
Medical Examiners ❑ Stephan Morris 3829 Hollywood Blvd. Hollywood Florida
Funeral (Name) (Address)
Home Riverside Memorial Chapel 1920 Alton Rd, Miami Beach, Florida 33139
Check A YI A completed certificate of death accompanies this application.
One
B ❑ Dr. _ was contacted on _— , 19 .
He has assured me that this death was from natural causes and that he will complete and sign
the medical certification of cause of death.
C ❑ The attending physician was unavailable or this death comes within the Medical Examiners
jurisdiction. The body was released to me byd 04) —
on "AAJ , 19
/ c5 G- - December 19, 1976
(Signature) (Fla. Lic. No.)
(Date Signed)
Funeral
Director Richard D. Mather
BURIAL TRANSIT PERMIT Permit 460-361
Permission is hereby granted to dispose of this body by burial, transportation out of state, storage or cremation. For
cremation a waiting period of 48 hours after death must be observed and the Medical Examiner's approval must
also be obtained.
❑ A five day extension of time for filing the death certificate has been requested and grantea.
rz Signature of�� Date
Registrar J' • Issued December 19, 1976
7-
/
f.'
CEMETERY OR CREMATORY
Method of Disposition Date of
VI BURIAL Disposition r � �
❑ CREMATION
❑ STORAGE Place of - -T 1 /-i
O OTHER (Specify) Dis osition . f1 t it f4'7 I -)-Ili- ` e.rteke/
Signature of Sexton , (1,j/ h,,,,, i "-- a v e--c..,.s 04,,,r-7/. Ati yi
or Person in Charge z/ 1 ) ,
This permit must be 71 or ed by the sexton or person in charge or by the funeral director when there is no sexton)
and returned within, 0 days to the local county health department.