Calhoun, Kenneth DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL—TRANSIT PERMIT
I NAME OF First Middle Last I DATE Month Day Year
DECEASED
(Type or print) KENNETH BRUCE CALHOUN (DEATH March 41., 1977
PLACE OF DEATH CITY, TOWN, OR LOCATION NAME OF (If not in hospital,give street address)
COUNTY Pasco New Port Richey, Fl. NSTITUTIONR Community Hospital
Attending Physician 12 (Name of Medical Certifier) (Address)
Medical Examiners ❑ T.D..Aylward, 310 High St, New Port Richey, Fl. 33552
Funeral (Name) (Address)
Home North Funeral Home, Rt 3 Box 2044, Port Richey, Fl. 33568
Check A ❑ A completed certificate of death accompanies this application.
One
B ® Dr. T.D. Aylward was contacted on March 7 , 19 77 .
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 0 The attending hysician was unavailable or this death comes within the Medical Examiners
jurisdiction. Th body was released to me by
,,,, ii)
on , 19
1398 March 7, 1977
(Signature) r:5-----------*----- (Fla. Lic. No.) (Date Signed)
Funeral
Director
BURIAL TRANSIT PERMIT Permit 965-11+2
No.
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 granted.
Signature of Date
Registrar ., Issued March 7, 1977
CEMETERY OR CREMATORY
,
Method of Disposition Date of r / `
ai <177
BURIAL Disposition , � 1lic.ey^
.CREMATION
0 STORAGE Place of ,'`` , � p
56 OTHER (Specify) R,Zmoatal,„, Disposition 'L"'`" v. C�� `
Signature of Sexton
or Person in Charge a
� /(-:/
This permit must be endorsed by the sexton or person in charge or by the funeral director when there is no sexton)
and returned within 10 days to the local county health department.