Bruhns, Helen COMMONWEALTH OF VIRGINIA BUREAU OF VITAL RECORDS AND HEALTH STATISTICS
DEPARTMENT OF HEALTH R►CHMOND, VIRGINIA
d OUT-OF-STATE TRANSIT PERMIT
~ FULL NAME AGE
a OF DECEASED He'e13 Roebling Bruhns 66 yrs.
-o PLACE OF (City or County) DATE OF (Month Day Year)
° DEATH Willis Wharf, VIRGINIA DEATH 9/lL,/75
_Q i SEX RACE OR
to w Female COLOR White
44 44 o DESTINATION TO WHICH y County) (State)
��, City or
4 REMAINS TO BE SENT
p o Seely, Cametary tupensFa, Y.
►w A Certificate of Death having been filed as required by the laws of this State, or conditions outlined in
regulations having been complied with, permission is hereby given to:
EFuneral
w Director Jack Dought, Address Exmore 9 Va. 23350
'4 To transport said deceased as stated above.
o
DATE REGISTRATION SIGNATURE OF
® dt
ISSUED g/15` t DISTRICT NO. 165 REGISTRAR $ ,66.4 ` leze '�
7