Gryboski, Steven ten
State of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
.1-H DATE PRINTED:August 11,2015 TRACKING NUMBER: 2015121552
1. DECEDENT INFORMATION
Name of Deceased Date of Death
STEVEN GRYBOSKI August 4,2015
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
PALM BEACH PALM BEACH GARDENS 9179 KEATING DRIVE
Name and Address of Funeral Home/Direct Disposal Estabiist went Fla.Lic.No./Reg.No. Phone Number
ALL COUNTY FUNERAL HOME&CREMATORY-LAKE WORTH F040760 F040760 (561)533-8878
1107 LAKE AVE
LAKE WORTH,FLORIDA,33460
Funeral Director/Direct Disposer Fla.Lic.No./Reg.No.
SHAUN LUYK F074525
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.
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Permit Number: 2015-F040760-6109
v v _ Date Issued: August 10,2015
State Registrar•
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 15 Approval Number: 151501010
4. CEMETERY OR CREMATORY
Place of Disposition: COMPASSIONATE FUNERAL CARE Method of Disposition: REMOVAL FROM STATE Date of Disposition: C_ f
I 1 1
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