Keech Jr, Donald State of Florida, Department of Health, Bureau of Vital Statistics
e ;
BURIAL TRANSIT PERMIT
HEATH DATE PRINTED:March 17,2015 TRACKING NUMBER: 2015043722
1. DECEDENT INFORMATION
Name of Deceased Date of Death
DONALD ROBERT KEECH JR March 16,2015
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
PINELLAS LARGO 11055 141ST STREET
Name and Address of Funeral Home!DirectDisposal Establishment Fla.Lic.No./Reg.No. Phone Number
SERENITY FUNERAL HOME F041198 F041198 (727)562-2080
13401 INDIAN ROCKS RD
LARGO,FLORIDA,33770
Funeral Director/Direct Disposer Fla.Lic.No./Reg.No.
GERALD F.SCHWEIZER F048406
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: 2015-F041198-5118
.Q„1. `J G/, _`e Date Issued: March 17,2015
State Registrar V �p-�
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 CREMATORIUM
Method of Disposition: REMOVAL FROM STATE Date of Disposition:
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