Stuart, Blanche STATE OF CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH
VITAL STATISTICS
Local Registrar's Permit for Removal of Cremated or Interred Human Remains
THIS PERMIT DOES NOT AUTHORIZE THE REMOVAL OF REMAINS
NOT PREVIOUSLY BURIED OR CREMATED
COUNTY OF i 1 o s a n g e l e.$,,l__-- ------
CITY OR TOWN OF_—_I.ngiex_oa d, California
DATE THIS PERMIT ISSUED August 101_ 1 7p49_
In accordance with the provisions of Section 7501 of the Health and Safety Code authority is hereby granted to
Applicant Samuel Pruyn
_.._ to remove the cremated/interred remains of
Deceased____Blanche Gertrude Stuart
Age____ ________ 72 — Sea Female
Place of death__Hol h'00 , California _-Date of death_�A 3 i—
Cause of death.__luta intoxication, carcinoma of stomach
From__-_____exton Pr. , Calif. to Glens Falls, New York
City or town City or town State
to be delivered to--Pine View Cemetery, for interment
C r e m#170 5 S --- Name of cemetery A p
Local eg trar of V al tatIstl s Registration District No. /
To be delivered to Edwards Brothers Co'Lon1LI Mortu ry
THE PERSON RECEIVING THE REMAINS AT CEMETERY MUST FILL IN AND SIGN THE FORM BELOW
AND DELIVER THIS PERMIT TO THE LOCAL REGISTRAR OF THE REGISTRATION
DISTRICT IN WHICH THE CEMETERY IS LOCATED
DATE REMAINS RECEIVED_ — � ----
SIGNE -- J& ` — &I"Cibet)1
This permit should be issued in triplicate. The original must accompany the remains to destination; the duplicate should be retained by
the person delivering the remains for removal and the triplicate must be kept on file by the local registrar who issues it for a fee of fifty cents.
87024 3-48 1OM®SPO