Buckingham, Sharon State of Florida,Department of Health,Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
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HEALTH DATE PRINTED:July 19.2021 TRACKING NUMBER: 2021136 59
1. DECEDENT INFORMATION
...._.
Name et Deceased
Data of Death
SHARON BUCKINGHAM July 15.3021
Place of Death-County City,Town or Location Name of facility,or street address If note facility
PINELAS LARGO SEASONS HOSPICE AT OAK MANOR
Name and Address of Funeral Home/Direct Dbpoeal Establishment Fla.Lit.NoJReg.No. Phone Number
AL:FETR!BUTE FUNERAL CARE.LARGO F22.1713 F2017 i3 (722)S$5..77S3
71.3 SEMINOLE BLVD
LARGO.Fl.OR!DA.33772
Funeral Director/D,ract Disposer Fla.Uc.NoJReg.No.
LEANA FAUSTINO f323940
Medical Verification Statement
RAMONA at the certifying pty sician's office,was contacted on Of/1412021 by the funeral director listed above:heletie indicated that
SUNIT SRIVASTAVA,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'. 2021.F20'713-5495
Date Issued: July 1a.2021
State Registrar
3. AUTHORIZATION for CREMATION,DISSECTION,BURIAL-ATSEA,or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: PINE VIEW CEMETERY
Method of Disposition: REMOVA:.FROM STATE Date of Disp
osition:
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.
OH 32SE.15'2
04V-1 Ott Fonda AciminisVasveCode
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Public Health Law Sec. 4145(2b) 012866
Receipt
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Human remains of^\}��' ' ;, s "r, delivered on ' J`a.� , 20 s4-- '
View Cemetery Representing the funeral home named on burial permit
> ficial Funeral Directors Reg.or License#
BUCKINGHAM
NAME Sharon Buckingham Age:
Lot Owner: William B. Buckingham Sr.
Lot# S.I lot 4 Sec 2 Grave# 1
Case: Concrete
Died: 7/1 5/2021 Interred:7/2 3/2 0 21
Funeral Home: Regan Denny Stafford
Cemetery: Pine View