Hamelin, Mary XAS STATE DEPARTMENT OF HEALTH PERMIT
REAU OF VITAL STATISTICS BURIAL—TRANSIT PERMIT NUMBER
1. Full name of deceased 2. Date of death(month,day,and year) 3. Death due to YESa
RSONAL communicable MARY A. HAMELIN JUNE 2,1974 di NO"LJ
TA ON
4. Sex 5. Color or race 6. Age in years 7. Place of death (city or precinct no.) (county) (state)
CEASED Female White 78 Brownsville Med.Center—Brownsville,Texas
Method of Burial 0 Cremation El Place of burial (name of cemetery or crematorium) (city or town) (state)
��,,, removal or
disposal Removata Disinterment❑ disposal Glens Fat l s,New York
NNER AND
Name of funeral director License number Business address
ACE OF Darling—Mouser Funeral HOme 5304 Brownsville,TExas
iPOSAL
Name of embalmer(if none,write none) License number Business address
Richard H.MitchelI 3777 Brownsville,Texas
A certificate of death having been filed as r qu ed by the laws of Texas and all laws and regulations governing the preparation and
THORIZA- disposal of dead bodies having been comp ed ith, permission is hereby given to dispose of the body as identified above.
)N TO
iPOSE OF Signature of local registr 1) District (city or precinct no.) (county) Date
DY J .W,Sloss . Brownsville,Cameron County,Texas June 2, 1974
Body was Date / Nam of cemetery oricrematory i
iPOSITION Buried i✓/IL- 3, I i 7 lt,(7,CpAil- ) �ka1\` SP Ce_. li-043C� x}
BODY L ation (city or town) (county) (state) Name of se on or person in charge ` J
Cremated Li ,, �t3 (4),`,,A,fi r... R.✓U. C_ , i f
1 u rY k�' a.4 , N'l l 7 �1 - r.G-L �, J ct ' '