Gardner, Myrtle State of Florida • Department of Health and Rehabilitative Services • Division of Health.
Burial Permit No.. /r 7/
BURIAL-TRANSIT PERMIT
Full name of deceased���
�� ,
' Place of death .(4. ...... ,.11!K � Florida
(City) (County) �A
Date of death.. '' 19 �� Color.... Sex.... Age
Method of disposal w71�
(Whether burial, cremation, transportation, storage, etc.) (Cemetery or Crematory)
County 4Y.J/l e.le State O (1
A certificate of death having been filed as required by the laws of is State, permission is hereby given
I. to License No //.5 7
(F eral Director or person acting as such) �yj�,�,�� �/
to dispose of body of said deceased as above stated. 1`�" � !�'�� .(�
Date issued......<ryJ� 775 Signature.. .. c .
(Registr8
Q METERY'OR CREMATORY AUTHORITY SHALL-)FILL OUT-SPACE BELOW
Body was d�v �t _ on 0I, -S 19 I in._ -t,,cy �/--= 1_e c.
(State whether cre ted, buried,stir d, etc.) ( etery or story)
—Place....... 1.....,L.. s 7i nature...,.....i. . -
(Sexton or person in charge)
V.S.#640 1 /
This permit must be endorsed by the Sexton (or by the Funeral- irector where there is no sexton) and re-
turned within 10 days to the Registrar of the district in which the burial takes place.