Hoag, Ethel —
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL-TRANSIT PERMIT
NAME OF First Middle Last DATE Month Day Year
OF
(Type orDprint) ETHEL _ HOAG DEATH April 2, 1980
PLACE OF DEATH CITY, TOWN,OR LOCATION NAME OF (If not in hospital,give street address)
COUNTY HOSPITAL OR
Martin Stuart INSTITUTION Stuart Convalescent Center
Attending Physician*3 (Name of Medical Certifier) (Address)
Medical Examiners ❑ Dr. Ronald Allison MD 921 S.E. Ocean Blvd. , Stuart, Florida
Funeral (Name) (Address)
Home AYCOCK FUNERAL HOME 505 South Federal Highway, Stuart, Florida
Check A 0 A completed certificate of death accompanies this application.
One
B rl Dr. Allison was contacted on April 2 ' 1980 _
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 physician was unavailable or this death comes within the Medical Examiners
jurisdiction. The body was released to me by
on _ , 19 .
nature)A As (Fla. Lic. No.) (Date Signed)
Funeral
Director I' , ar., _/,, , _ 1576 April 3, 1980
4.00BURIAL TRANSIT PERMIT Permit 706- 1093
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.
0 A five day extension of time for filing the death certificate has been requested and granted.
Signature of • . Date Apri 1 2, 1980
Registrar ... a Issued
CEMETERY OR CREMATORY
Method of Disposition Date of
® BURIAL Disposition May 1980
❑ CREMATION Place of
❑ STORAGES n
Disposition -- spas
❑ OTHER (Specify) CCffieter'y
Signature of Sexton ,------
or Person in Charge
This permit must be endorsed by the sexton or person in charge tor by the funeral director when there is no sexton)
and returned within 10 days to the local county health department.
HRS Form 326 (1/77)
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) MARGARET MORRELL LAMBERT DEATH
Feb. 19, 1980
PLACE OF DEATH CITY,TOWN,OR LOCATION NAME OF (If not in hospital,give street address)
COUNTY HOITAL OR
Volusia Daytona Beach INSTITUTION TION Halifax Hospital
Attending Physician E4 (Name of Medical Certifier) (Address)
Medical Examiners ❑ Dr. James A. Carratt, 1243 S. Ridgewood Ave. , Daytona Bch,F1 .
Funeral (Name) (Address)
Home Baggett & Summers, Inc. , 736 S. Beach St. , Daytona Beach, Fl.
Check A ❑ A completed certificate of death accompanies this application.
One
Carratt Feb. 20, 80
B [x 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 release. o me by
on ,19
--�/S if/3 2 :/ -moo
(Signature) // (Fla. Lic. No.) (Date Signed)
Funeral
Director
BURIAL TRANSIT PERMIT Nermit 1689-1373
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.
Iiil A five day extension of time for filing the death certificate has been requested and granted.
Signature of � Date
Registrar �J (?14o,,a. Issued Feb. 20, 1980
CEMETERY OR CREMATORY
Method of Disposition Date of i 1
❑ BURIAL Disposition " pa�/��,..e.r 6
❑ CREMATION �,�, f`4� I, -4
[-STORAGE Place of r
[IIJ�l_
OTHER(Specify) .�x;.. Disposition `
--...c..e.. ......4fk211 ,.7./S
Signature of Sexton
or Person in Charge
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.
HRS Form 326 (1/77)
J