334 NE 101 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date 7 ( 1 4 H Z— Job Address 33'1 N JO S \ Tax Folio // 2r A6 /3 -5
Legal Description 4 '7 S ve kv/.)7.44.39 AJ St(' • //5W9).
Owner / Lessee / Tenant �nT _�� ''1' w ' O&IY `' - S Master Permit #
Owner's Address * OF lG 1 `5\0ca Phone Pc-9-9
Contracting Co. NNe_A &UI LOe'L --- Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I 2 L—& 1( 1 cJ bCriA- To
PPPc Ce 4 . _ r./ 5 C C U - ibeQ►'t-a61
Square Ft. Estimated Cost(value) 30
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating /construction and zoning. Furthermore, I
authorize the above -named contractor to do the work statg . i
Signature of owner and /or Condo President
Date:
APPROVED: Fire
Signature of
/ D e , : 7 5i/
P/1- rir�c,c�.
NOTARY
Other
72.45114c qe--
or Owner- Builder
Notary as to Owner and /or Condo Preside ^aQ A.6 f,Notary as to Contractor or Owner- Builder
My Commission Expires' Print type or stamp name cM ogmr$b lion Expires:
Personally known FOR Produced I.D. NOTARY PUBLIC STATE OF FLORIDA
Ty e an number o I.D. produced: MY COMMISSION EXPIRES 5/09/94
** * * * * * * ❑ 10 take an oath or * * * Bonded hru Stern ler- Adam3� & Sweet**
[';SID NOT take a
FEES: PERMIT .3 RADON C.C.F.
TOTAL DUE 73
Zoning Building/5 hl '/ 9 . Electrical
Mechanical Plumbing Engineering
IN RE: ESTATE OF
BARBARA MAE KIRCHHOFF,
Deceased
LETTERS OF ADMINISTRATION
TO ALL WHOM IT MAY CONCERN
WHEREAS, _ Barbara Mae Kirchhoff , a resident of
Dade County, Florida, died on Maic?-3 , 19 92 owning
assets in the State of Florida, and
Glenn Martens Kirchhoff
WHEREAS, has been appointed
personal representative of the estate of the decedent and has performed all acts prerequisite to
issuance of letters of administration in the estate,
NOW, THEREFORE, I, the undersigned circuit judge, declare
Glenn Martens Kirchhoff to be duly qualified under the laws of the State of Florida to act as
personal representative of the estate of —garb ara Mac Ki rchhoff
deceased, with full power to administer the estate according to law; to ask, demand, sue for, recover
and receive the property of the decedent; to pay the debts of the decedent as far as the assets of the
estate will permit and the law directs; and to make distribution of the estate according to law.
STATE OF FLORIDA
COUNTY OF DADE
I, THE UNilERSIGNt '$pQZtc @IP,G(�,Cj{cr;,IC kt seal of this court this da . , 19 92
.
County. Florida. DO H _ QY �� e W c
ing is a ;rue and correct cony of the original as it appears
on record and file in the office of the Circuit Court, Dade
County, Florida and that same is in full force and effect.
WITNESS my hand and Seal of the Circuit Court at Miami,
Florida, this day of
AD. 19. tpcy .. 1992
-.i Clerk Circuit
BY,,
Deputy
4. i `A /.
Ork Circuit Court
.
L Sj iE! 2P
r.i=rC:ii t:U 4 vi
IN THE CIRCUIT COURT FOR
DADE COUNTY, FLORIDA
PROBATE DIVISION
File Number 92 - 02
Division
04
uit Judge
EDMUND W. NEWBOLD
CERTIFICATE OF DEATH
FLORIDA
E krNOcdr
'nnK BONE •
num. MOM
wuntorto
!FE 00 NOI
1ST nF. Temp
LAST
KII HHOFF
6 DATE OF BIRTH (Monet . 08 T "
January 03, 1927
9a PLACE,OF DEATH (Checkooty one: seeln.$1*.tions on otharaide)
HOSPITAL$ npatrent $)'ER)Outpetlanl , (LUOA OTHER:.I) Nursing
Home L1 Residence I'Other (Specify)',::'
9e, FACILITy'NAME pl nO! insftftPiO ,give street and ntm imi)
N orth'ShoreMedical Centex
10a. DECEDENT'S USUAcpccUPATION .
F'larida
13n t ►ISIDE CIIY,
LIMITS/ (Sri'aNe)
19a INFORMANT'S NAME'(rypp/Prie/T
Kimberly Kirchhof f
20. ME THOO OF DISPOSITION
I I Burial c)U rernetlon t 1 Removal (rom:State
I I Donation 1 TOther (Specify)
21a SIGNATURE OF FUNERAL SERVICE LICENSEE OR
:: PERSON. i('9 AS SUCH •
4. SOCIAL SECURITY NUMBER
261 -30 -9233
.,_7. BIRTHPLACE (City and State or Foreign Country)
Port Huron, Michigan
1 KIND OF eUSINESSnNDUSI n
Veterinarian's
Office.,
11 MARITAL STATUS :'Married;
Never Married, Widowed
Divorced (Speedy)
Widowed
Miami •.. Shores
14. WAS DFCEDENT,OT' HISPANIC OR HAITIAN ORIGIN?
(Specify. or )bs � yes. spocity Haitian. Cuban,
Mexican;Puerto RicalMc.) Lid No 1.1 Yes
SPecil ':'. • .
11 rATIIEn'S NAME (First, Middle, Lest)
Al ton.:::
21b. LICENSE NUMBER
(01 Licensee)
22. To the best knowledge 'dear urted at the time, date a d and due 10 the
causa(s) !Med. I
bu /'
. :.. S(gnaluNandTitla ::� 14 ` '' i ( (. t ( .. )j , L
0 *' 22b DATE:SIGNEp(1N0 060;:ri) 22c HOUR DEATH
ga Z.
��o L 8:13 P �.
75. SUBREGITRAR ` - ':StONAtIJAEANDAATE
32e PLACEOF INJURY:- AI home. farm,
:; si'reel. factory. etc. (SpociY))
9d. CITY TOWN OR LOCATION OF DEATH
Miami
20b. PLACE OF DISPOSITION (Name of Cemetery, cnrmaforyor:?
other place)
South Florida Crematory
27a. WAS AN AUTOPSY
PERFORMED'
(Yes or No) _..
30a: IESt)AOERY IS MENTIONED IN PART for It ENTER CONDITION FOR_WIIiCH IT WAS PERFORMEo '`
32A:OAIE OF INJURY '• •
.::. :; ( Month, Day, WHO'
5b. UNDER .1 YEAR:
2:SFx
Female •
5c UNDER 1 Day:_
8. WAS DECEDENT EVER IN U S
ARMEQ FORCEST' (, No)
NO
:•9b,1NSIDE.,C11V (Ms or N
12; SURV,V.ING'SPOUSE:(11 wile, give maiden name)
19.'0ECEpEN1 SEDUCATION
- oery hrgnesl grade cnmprere
S FMrn 512,
90 (Replaces
Wolfe editi
31..:pROaA @LE MANNER '
()FAIN(Specl(Y) Nattual
Accidehl,ESUicide homicide .
or undete(mIned:
THIS
IS !;:A CERTIFIED TRUE AND CORRECT COPY OF THE O RECORD ON T ILE IN THIS OFFICE
MAY 019
OLIVER' BOORD ..
State Registrar
ANY REPRODUCTION OF THIS DOCUMENT IS PROHIBITED BY LAW. DO NOT ACCEPT
UNLESS ON .S PAPER WITH LINES AND :SECURITY ; .WATERMARK ON BACK .
AND COLORED BACKGROUND AND GOLD EMBOSSED GREAT SEAL OF THE STATE OF
FLORIDA ON FRONT. ALTERATION OR ERASURE OIS':'>CERTIFICATION.
HRS FORM`1564A (7.91) •
19,:RACE American Indian BO:
aleck WheIc.
Whit
18. MOTHER'S NAME (First, Middle. Maiden Surname)
Myrtle Uno;bt )
19b. MAILING ADDRESS (Streetand Number' M Rural Roufe.MObel, City or; ?own, Stele.:7ip Code)
334 N.E. 101 Street •Miami, Shores'FL 33138
iami, Florida
21c. NAME AND ADDRESS OF FACILITY
Bess Ko1ski-- Combs: Funeral :Home
10936 N:E. 6:th Avenue Miam_;F'L
23a Oh the.basis •of exarnination and/or Irw esligetion in my d un
ptnlon death occnd:
the time, date and;place and due to Iha ceufe(f) •and manner as stated
SIgnature and T1tle A
.23b DATE SIONED (Mo., Day, A)
ag
8' 23d PRONOUNCED DEAD(Ma Day, Yr.)
4
•
8 22d NAM n F ATTENDING PHYSICIAN;IF THAN CERTIFIER (Type or Print)
Enter the diseases, Injuries, or compticalions at cau, ed the death
or heart failure. List only one cause on each line.
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IMMEDIATE CAUSE )Final
drsoaye 0r cbndifron
resulting (h death)
Sequeriiiallyllst conditions
1180y;')eadingg to inir iediate `•
'Cause:; Enie'r'U NDEIRLYING:'
CAUSE(bisease or Injury`
Thal initiated events
resulting in death) LAST.
29 IF FEMALE, WAS THERE A
PREGNANCY IN THE PAST
3 MONTHS'+ I YES XX'IO
iCC'd7i el; CI: 4 Lei r c `
DUE TO (OR AS A CONSEOUENCE OF)
?DUE: TO (OR.AS ACONSEOUENCE OF)
:PART 11 (Nher signlhcaIlcond)Ilort. conlrbuhng (0 death birl - not resulting in the
unr)erlyingcau5e given m Parl t:
• 25c DATE REGISIEIIED
MAY 199'
Do not enter only the mode of dying, such as cardiac or respiratory arrest, shock, Approximate Interval
I Between Onset and
Death
?7b WEnE AUTOPSY FINDINGS
USED TO COMPLETE.:
CAUSE OF DEATH? (Yes or No)
',78 CA t.)TEPOIT'1.
TO MEDICAL
E % AMIt4r.n7
(N±s or No)
Yes •
sflb GATE OF SURGERY. (Ma: Day. ri•nrl
32d': DESC.R19E HOW INJURY OCCURnED
32f. LOCATION (Street and Number ca Mira) Route Number. Crt y or Pawn' . Slate)':
R ECORi