Cullen, Robert MState of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
1-1F11111-1 DATE PRINTED: July 2, 2020 TRACKING NUMBER: 2019082391
1. DECEDENT INFORMATION
Name of Deceased Date of Death
ROBERT MORSE CULLEN May 9, 2019
Place of Death - County City, Town or Location Name of facility, or street address If not a facility
PINELLAS CLEARWATER MORTON PLANT HOSPITAL
Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number
FLORIDA DIRECT CREMATION F040344 F040344 (727) 525.9219
3121 44TH AVE N.
ST PETERSBURG, FLORIDA, 33714
Funeral Director/Direct Disposer Fla. Lic. No./Reg. No.
PHILLIP ROUZER F044246
Medical Verification Statement
DOCTOR ASSIF at the certifying physician's office, was contacted on 05/21/2019 by the funeral director listed above; he/she
indicated that EDUARDO PASCUA PALANCA, 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: 2019-F040344-5288
Date Issued: May 17, 2019
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 6 Approval Number: 71906510
4. �-� CEMETERY OR CREMATORY
Place of Disposition: DIRECTORS SERVICE INC
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
RECEIVED
JUL.t' 202L1
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS
EDWARD LOWREY CULLEN
2678 TUCSON WAY
POWDER SPRINGS, GA 30127-1562
i7 - Zv
Date
Pay to the C/N 4",/ b 4 C t - G. v 4J 6,(-.44.-$
Order of
Th ti r 4-y (- 4? -51-e Dollars
QPNCBANK
PNC Bank. N.A. 040
For RDitre-r'r Of. cvl)ta but:4 l
a:054000030.: 5 344 1 2 183711' 0 130
130
153/646
169
CI REF FINANCIAL OFFICER
JIMMY PATRONIS
STATE OF FLORIDA
August 4, 2020
Mrs. Karen Vaughan
City of Clearwater
600 Cleveland Street 6th Floor
Clearwater, Florida 33756
Re: ATN — 34974, Sylvan Abbey Memorial Park and Funeral Home
Dear Mrs. Vaughan -
Thank you for submitting your complaint to the Division of Funeral, Cemetery, and Consumer
Services. Investigator Kurt Schuller reviewed the documentation and correspondence you
provided. In addition, Investigator Schuller contacted Sylvan Abbey Memorial Park and Funeral
Home regarding your complaint and obtained additional information.
The investigation determined possible violations of chapter 497, Florida Statutes. We will review
your complaint for consideration of administrative action. Therefore, at this time, we have
concluded our investigation.
We appreciate you bringing this matter to our attention and hope we have been of service to you.
If you have any questions, please contact Kurt Schuller at Kurt.Schuller@myfloridacfo.com or
(813) 218-5391.
Sincerely,
fit
Nicole Singleton, CPM
Investigation Manager
Division of Funeral, Cemetery, and Consumer Services
Department of Financial Services
NS/ks
FLORIDA DEPARTMENT OF FINANCIAL SERVICES
Nicole Singleton • Investigation Manager
Division of Funeral, Cemetery, and Consumer Services
200 East Gaines Street • Tallahassee, Florida 32399 • Tel. 850-413-4987 • Fax 850-413-4958
Email • Nicole.Singletonamyfloridacfo.com
AFFIRMATIVE ACTION • EQUAL OPPORTUNITY EMPLOYER
INTERMENTS
BURIAL
SP TYPE
1 INFANT
1 INFANT
2 INFANT
2 INFANT
3 FULL
3 URN
4 FULL
5 FULL
5 URN
6 FULL
7 FULL
8 FULL
9 FULL
10 INFANT
11 FULL
12 FULL
13 FULL
14 FULL
DECL
CULLEN
CULLEN
CULLEN
CULLEN
CULLEN
CULLEN
CULLEN
PHILLIPOFF
PHILLIPOFF
PHILLIPOFF
CULLEN
TUCKER
CULLEN
FINCHER
CULLEN
CULLEN
CULLEN
CULLEN
DISINTERMENTS
Status of Block: 4 LOT: 15 as of 7/30/2020
DECF DECM BIRTH
MARJORIE
ROBERT
LOUIE
LOWREY
LINNIE L
ROBERT M
THOMAS L
JOHN D
IVAN D
GRACE C
ROBERT T
AMELIA L
CYRUS
INFANT
CHARLES E
EMMA
MARGARE
T A
C W
12/5/1902
1/23/1897
10/4/1899
8/6/1908
1/1/1879
8/24/1943
1/1/1904
1/1/1869
11/7/1910
1/1/1875
1/1/1868
1/1/1861
11/16/1917
1/1/1946
1/1/1864
1/1/1862
1/1/1836
8/8/1826
DEATH INTERRED PERMIT
4/17/1903
1/24/1897
10/9/1899
12/24/1909
5/25/1963
5/9/2019
3/18/1969
6/30/1955
3/18/1985
5/7/1954
1/1/1939
1/1/1941
12/29/1994
1/1/1946
1/1/1908
1/1/1905
2/11/1924
11/9/1899
REINTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH
SP TYPE
5 URN PHILLIPOFF IVAN D 11/7/1910 3/18/1985
4/17/1903
1/24/1897
10/9/1899
12/24/1909
5/25/1963
5/9/2019
3/19/1969
6/30/1955
4/4/1985
5/7/1954
1/1/1939
1/1/1941
1/3/1995
1/1/1946
1/1/1908
1/1/1905
2/11/1924
11/9/1899
INTERRED
12/2/1995
0
A
0
0
282
1483
690
1157
1611
1092
0
0
1219
0
0
0
0
0
INFORMATION REPORT FOR: BLOCK: 4 LOT: 15 SPACE: 3 7/30/2020
CURRENT OWNERS
OWNER 1:
MRS. CULLEN
OWNER 2:
SPACE TYPE: RELATION TO OWNER 1:
CURRENT SALES INFORMATION
PREINTERMENT INFORMATION
INTERMENT INFORMATION
DECEASED: LINNIE L CULLEN RIGHTS:
INTERRED: 5/25/1963: BURIAL TYPE: FULL
BIRTH: 1/1/1879 DEATH: 5/25/1963 PROCESSED:
DIRECTOR: PERMIT#: 282
NOTES: None
DECEASED: ROBERT M CULLEN RIGHTS: 7/30/2020
INTERRED: 5/9/2019: BURIAL TYPE: URN
INFORMATION REPORT FOR: BLOCK: 4 LOT: 15 SPACE: 3 7/30/2020
BIRTH: 8/24/1943
DIRECTOR:
DEATH: 5/9/2019 PROCESSED: 7/30/2020
PERMIT#: 1483
NOTES: RECEIVED $30.00 STAKING FEE FROM EDWARD L CULLEN, BROTHER OF ROBERT M
CULLEN.