Bowen, Robert FLORIDA DEPARTMENT OF
HT�TL T State of Florida, Department of Health, Vital Statistics
L-+ APPLICATION FOR BURIAL-TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased Robert A. Bowen of February 21, 2011
Death
2. Place of Death City,Town or Location Name of (If neither,give street address)
County Lee Cape Coral Hosp.or
Inst. Hope Hospice-2430 Diplomat
3. Name of Medical Address Phone Number
Certifier Luis Espina 2430 Diplomat Pkwy, Cape Coral
ElMedical Examiner 1Physician Florida 33909 (239) 652-1205
4. Name of Funeral Horne/Direct Disposal Address Fla.Lic.No./Reg. No. Phone No. (Area Code)
Establishment 3453 Hancock Bridge Pkwy
National Cremation&Burial Soc N. Ft. Myers, Florida 33903 F041931 (239) 995-1113
5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. 0 Dr. Espina was contacted on 2-21-11
He/she verified that this death was from natural causes,that there was no accident nor other external cause of death,
and that Dr. Bspine will complete and sign the medical
certification of cause of death within 72 hours.
C. r-1 j was contacted on He/she verified that
, Medical Examiner,will complete and sign the
medical ce ification of cause of death within 72 hours.
6. Funeral Director/ n re F�. N ./Reg.No. Date Signed
Direct Disposer fy • TO /ff/ 2-22-11
B. BURIAL-TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 41831-2011-0151
E A five(5)day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical ical certification of cause-of-death section of the death certificate within
72 hours.
No extension of time for f• g th death certificate has n requested.
tiSlits/64aL _ ( Date Date Certificate
Subregistrar Signature • Issued: 2-22-11 Due: 3-3-31
C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number. (_' `F/ Date , _ �}; --r , • /
• J / 1 f i - gave authorization bytelephone toNational Cremation & Burial Soc
Medical Examiner, j}�; �� �_ (� j} -� p
'-funeral Director/Direct Disposer. Date -
�� � 11
The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting pel cad of 48 hours after death is
required for all cremations.
Tan Mn....,r4 of Dori.
D. FOR FUNERAL DIRECTOR/DIRECT DISPOSER USE ONLY
1. Date Burial-Transit Permit(pink copy)was filed with Local Registrar:
2. Date Temporary Certificate was filed with Local Registrar:
3. Date Permanent Certificate was filed with Local Registrar:
4. Follow-up efforts&activities(Note parties&dates contacted):
5. Name and place of disposition: Pine View Ceietery, 21 Quaker Pd. Q.ffl shRy, NY 12804
6. Funeral Director/Direct Disposer Report Filed: Yes No Date Filed:
FUNERAL DIRECTOR/DIRECT DISPOSER COPY
DH 326,8/97(Obsoletes all previous editions)
(Stock Number: 5740-000-0326-2)