Dolan Sr., Robert t
j -,
F ti !�"o. State of Florida, Department of Health,Bureau of Vital Statistics
SALT BURIAL TRANSIT PERMIT
DATE PRINTED:January 14,2014 TRACKING NUMBER: 2014005118
1. DECEDENT INFORMATION
Name of Deceased Date of Death
ROBERT E DOLAN SR January 10,2014
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER
Name and Address of Funeral Home/Direct Disposal Establishment Fla.Lic.No./Reg.No. Phone Number
SEAWINDS FUNERAL HOME F073380 F073360 (772)589-1933
735 SOUTH FLEMING STREET
SEBASTIAN,FLORIDA,32958
Funeral DirectorlDirect Disposer Fla.Lic.No./Reg.No.
ANTHONY GABBARD F044749
2. BURIAL -TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382,Florida Statutes.
Permit Number: 2014-F073380-5011
C.
G! la •t Date Issued: January 13,2014
�c. �J
Meade Grigg,State Registrar
3. AUTHORIZATION for CREMATION,DISSECTION, BURIAL-AT-SEA,or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: PINE VIEW CEMETERY
Method of Disposition: REMOVAL FROM STATE Date of Disposition: 2/8/2014
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit,therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
OH 326E,10/12
64V-1.011,Florida Administrative Code