Eversley, Cleveland QJrrtifirat of !Irrmatinn
q_
. ,
Troy, New York, June 1 3, 19 80
The undersigned, being on this date the Administrator in charge of the
(far 1tier krarl Memorial Cnhttirl anI Q rrmaturium
hereby certifies that the remains of Cleveland A. Eversley
were Cremated on the 12th _day of June 19 80
That the burial permit, pre-requisite to the Cremation of the Remains,
accompanied the same, and that it shows June 12, 1980 as the
date of death; _ Congestive Heart Failure as the cause;
MEMBER and 52 Yrs. as the age. �'�' �'"A'
%I__"it t�ttrdurr art- rmuria tl[!!tt}�st and tlir tturiuui
/ `J: BY
TROY CE T .RY ` C ON .
c KW
.: No 68389 I
CREMATION uperintendent
ASSOCIATION OF mmu. THIS BURIAL CERTIFICATE S D ACCOMPANY THESE REMAINS TO THEIR D TINATION