Schwenker, Charles Ohio Department of Health
Vital Statistics Burial-Transit Permit-Not Valid for Cremation Permit no. 723388
Name of Deceased Date of Death
CHARLES RICHARD SCHWENKER June 22, 2013
Personal data sex Age Place of death(Village or City) County
on deceased Male 64 Years VANDALIA MONTGOMERY
Cause of Death
Manner and 0 Burial IN other(specify) Removal from State
place of
disposal Name of Cemetery
Maynard D. Baker Funeral Home
A-satisfactory Certificate of Death or Provisional Certificate of Death has been filed as required by the laws of this state.Permission to dispose of the body
as indicated above is hereby given to:
Authorization Funeral Director Address
to dispose of HARTZELL, DAVID TOBIAS 327 W MAIN ST
body TIPP CITY, OH 45371
BAYLIFF9JAMES 550raOtiemdietnctre. June25, 2013
HEA 2721
Rev.01/07 This permit must be retained by superintendent or person in charge of cemetery for a period of five(5)years
Re.m ,'-? '10 ..ct---\ \ p
,----- 6://1-6
130-ok- _ff2_, 1 her r