Giroux, Roland State of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
* a
Wan DATE PRINTED:June 14,2016 TRACKING NUMBER: 2016094687
1. DECEDENT INFORMATION
Name of Deceased Date of Death
ROLAND ROSAIRE GIROUX June 13,2016
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
LEE CAPE CORAL 2699 BLUE CYPRESS LAKE COURT
Name and Address of Funeral Home/Direct Disposal Establishment Ha.Lic.NoiReg.No. Phone Number
MULLINS MEMORIAL FUNERAL HOME&CREMATION SERVICE INC-CAPE CORAL F079336 F079336 (239)242-0909
1056 NE 7TH TERRACE — _ - -
CAPE CORAL,FLORIDA,33909
Funeral Director/Direct Disposer Fla.Lic.No./Reg.No.
SHANNON D.MULLINS F044369
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: 2016-F079336-5219
� -.--— Date Issued: June 14,2016
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: 6/2 5/201 6
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.
DH 326E,10/12
64V-1.011,Florida Administrative Code
Giroux
Owner
Jeannie Giroux
Address 402 Lower Main St. Hudson Falls 12839 Plot
Cayuga #1
Phone # Lot #
51 8-747-41 39 Al -6 & Al -6 ( 1 2 )
Deed # Date orginal date
4434 12/10/2010
Cost720o Foundation Y - N
Location West- Tree-Line
North - Vacant
East- Vacant
South- Road
Remarks These 12 lots were switched for 12 lots in Erie
To accomadate designed monument and Roland wishes.
Record of Interments
1 6
2 7
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4 9
5 10
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GIROUX
NAME Roland Rosaire Giroux Age: N
Lot Owner: Jeannie Giroux
Lot# Cayuga # I, A13-18 Grave# 15
A 1 3-1 8
Case:
Concrete
Died: 6. 1 3 .2 01 6 Interred6.2 5.2 01 6
Funeral Home: Carleton FH
Cemetery: Pine View