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State of Florida, Department of Health, Bureau of Vital Statistics
rifetelitewerserBURIAL TRANSIT PERMIT
HFe1TH DATE PRINTED:November 20,2020 TRACKING NUMBER: 2020215810
DECEDENT INFORMATION
Name of Deceased
Date of Death
JANE MARIE GRIFFIN
November 16,2020
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
LEE ESTERO LIFE CARE CENTER OF ESTERO 3e50 WILLIAMS RD.
Name and Address of Funeral Home/Direct Disposal Establishment Fla.Lic.No/Reg.No. Phone Number
HODGES KISER FUNERAL HOME F040489 F040489 (239)481-4341
9231 CYPRESS LAKE DR
FORT MYERS,FLORIDA,33919
Funeral Director/Clrect Disposer Fla.Lic.NoJRag.No.
WILLIAM J HANSEN
F043477
Medical Verification Statement
Lisa Shepherd at the certifying physician's office,was contacted on 11118/2020 by the funeral director listed above;he/she indicated
that CHARLES PHILIP FRIEDRICH,certifying physician,will complete and sign the medical certification of cause of death within 72
hours.
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-F040489-5181
� --- Date Issued: November 17,2020
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA,or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 21 Approval Number: 06364
4. CEMETERY OR CREMATORY
Place of Disposition: LEE MEMORIAL PARK CREMATORY / tt
Method of Disposition: CREMATION 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
Griffin
NAME Jane Marie Griffin Age:
Lot Owner: Mr & Mrs Edward Griffin
Lot# S&I #2 Grave# 2
Case: Urn
Died: 1 1 /1 6/2020 Interred: 6/25/2021
Funeral Home: Hodges Kiser FH FT Myers Fl
Cemetery: Pine View