LeMay. Brienne LF
State of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
frofida
HEALTH DATE PRINTED:December 10,2020 TRACKING NUMBER: 2020230792
�. DECEDENT INFORMATION
Name of Deceased Date of Death
BRIENNE LEMAY December 8,2020
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
ST JOHNS ST AUGUSTINE 1-95 N,NEAR MILE MARKER 320
Name and Address of Funeral Home/Direct Disposal Establishment Fla.Lic.No./Reg.No. Phone Number
JONES-GALLAGHER FUNERAL HOME LLC-STARKE F047902 F047902 (904)964-6200
620 E NONA ST
STARKE,FLORIDA,32091
Funeral Director/Direct Disposer Fla.Lic.No./Reg.No.
JOSEPH A GALLAGHER F042086
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: 2020-F047902-5321
Date Issued: December 9,2020
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 23 Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: PINE VIEW CREMATORY
Method of Disposition: REMOVAL FROM STATE Date of Disposition: o'?-I`D'moo
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
Public Health Law Sec. 4145(2b)
012828
Receipt
Human remains of_4_ delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
LEMAY
NAME Brienne LeMay Age:37
Lot Owner: Arthur LeMay
Lot# Horicon 17 A Grave# 1
Case: Concrete
Interred:1 2/1 5/2 0 2 0
Died: 1 2/8/2 0 2 0
Funeral Home: Baker FH
Cemetery: Pine View