Hecker, Meriam BURIAL — TRANSIT PERMIT
Name: First Middle Last Sex
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Date of Death Age If Veteran of U.S. Armed Forces,War or Dates
1-1 c.'yL• rii B eke f)l MP) to
Z Place of Death: City,Town or Villdge Hos ital, Institution or Street Address
A
/a� 639/!J Y /'2eD/Y/)L ( Eni e N JSit/l/7 tv/Gtj Y 9/'/
Causes of Death:
w t9R D//IC. /9 e e 37
A Medical Certifier: Name Title Address
�1; r i 5 •UEve) PhD �e6 A)1 'T 0, lTee .i/OSPi7
Death Certificate Filed:City,Town or Village District No./`l / Register No.
g> Burial: Date Cemetary or Crematory Address
Cremation: $}i�✓�QCI TefILl}i 6'LI- it,'S /"''?Cc.Si A",r.,,
Removal Date Place Removed and/or Held Address
O Z ❑ and/or Hold:
H
Cl) Date Point of Shipment Destination
p Transportation by
❑ Common Carrier:
A Date Cemetary Address
Disinterment:
Reinterment:
Permit Issued To:Name of Funeral Firm A dress Registration No. ('/y j�`
l 11//r/� /?r•rilexir/aL C/t,3f C l'i-Y , A9fG�,WSiJi/2G;d/-✓ , l/ 1 A647
Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other Than Above:
I- Address:
c4 Permission is hereby grante,{�t dispose of the dead human remains described above as i dicated ,
a Date Issued 3 E? 1 - oLok) ) el 8 L A-� 13. p-L�t,y e--t
Registrar of Vital Statistics"( iS gnature)
District No. I G
his permit must be completed on back by the person in charge at the place of disposition an, ifed with the registrar of vital stati s 6f the city,t, or village
where disposition took place.