Van Norden, Doris VEW ORLEANS CITY DEPARTMENT OF HEALTH BURIAL-TRANSIT PERMIT rc.2L-,C0 '
BUREAU OF VITAL STATISTICS ��
In Cooperation with the Louisiana State Department of Hea th
Name of t ��0 ,�P4 N°. 45974
°/
)ECEASED: . +' r /1 / d Sex. Age:
dace of Date of v �' ...7
)each: -./ Death: �-0 19
(City or Town) (Parish) (Ward)
A Certificate of Death having been presented as required by law, permission to dispose of the body of the above named n
dent, is hereby grated
I17 et...0.1„.....A... )71 s AkZ•freall.0
To: (Name of Funeral Director or other such person) (Signature of Local`oc Registrar))
/3oo 4E P. _ By. Orle�s Parish 2" +-r+
e)Director t*" ✓�'
(Address of Funeral ) "`
I am duly licensed to practice embalming by the Louisiana State Board ,..!e' -t`
of Embalming and Undertaking, or by a similar agency possessing like I Wave registe ell'�w th e au prize healifi depar meet o / far; aye
0A ✓i S / a h a complied with the laws of the State of .� regarding fins!sposal
powers in the State of , and have prepared /J�
the body of this decedent for final disposal by: dead hu bodies, and have i t-C.z ' s decedent og `' %5 I 'rt
(Bun Crc tc.) / rp
, 0
Met od f Embal ing w Preparati n Date / Cemetery r Cre tort'
�/"/�_�, �/ t_ Addres Lot No.
Embalmer. _AY / ° /� k-i 0`3° Sexton's Signature:_ --"-��� ab ddresst ...--
License No.
THIS PERMIT MUST ACCOM my IIE AINS TO DESTINATION RETURN PERMIT TO REGISTRAR OF PARISH OF BURIAL WITHIN 10 DAYS