Deihl, Thomas NEW ;Ir Vr,�• .7#+4TE ��P.+�t l'"tTI�il�l'�� �C" HEALTH
�.ritt7l ,� -Ur�is tiliri Burial - Transit Permit
j Narr-ir. 'first Medic, Last Sex 1
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Lathe tot L ath Aoe it'Veteran at U,S, Armen Forces.
�5 Place ui Death I+ c pikal Iristiltr'irr 1 Or -
t city. ...7. , r vrriar eGran V i t I ', Street Address i_ �._ no �;tS�, ..
r'w` S r-••° Undetermined P riding-_ ._
ID tdlarrnt.r ref prt.athNatraral Cause Accident ❑Homicide Sum i_
Circumstances Investigation
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Derain ficii1 Fil=d Disl•ic- NumberR garter Natrrib r
❑Eiria► Cate � e r Cremat ry ,
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D.Cremeilion . � n5
Date+ t°I�i_a Removed-�' Ft�,nu��ai and stir Meld
rand or �{r.lrjrea.,.
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l Date F ui l it 3f
{�A t =Traci � sit or Shipment
0 by uurrrrnori Des'.rnairci,
Carrier
Date'
Cemetery Address
Disritt4rrr olt
i,t Date Cemetery Address
❑Ffrritarrri
1 Permit issirorl tc Registration Number
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I. AddiesiLi
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Name of Fcirier;il f-irrti M.tkirira 1isprjsatiun or to v.li,Jr--3
t Remains are Shipped, 10 Wither than At;Mie
Address
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d.1 Permission is hereby granted to dispose of the human remains described above as tridicate•d.
I Date Issued 0510/a016 Registrar of Vital Statistics ?n/tz-Y14. °1-,‘A-ifVeitr fie1a
District Number- srls.6 piaci-,
I certify 'Aar !tic, remains of the decedent identiii-ed ahidve were disposed of in accordance with this per alit on.
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DOH-1955 :2 230r04i