Eggleston, Shirley i 1
\eh' YCRr -3TATE CEPARTNIENT OF HEAL-t-i #151
V11,11 Records Sechur Burial - Transit Permit
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Gate et Death 3 Acre li . .e.A.Ibt an t....4 U.S. Ar ort Forces
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1....: Place 11-1 Deatti --Llapital instiriutivri or
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0 Marimr rf Death Xi Natural Cause 1-1Aceident I i Heimicide Li Suicide rj- Undetermined ni-Reriijing
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C.:,`Irnurrist.ahoes "'-' Invrti.F.tigaton
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Death C-ertilicale FliP. Dti 1!id Nurrib.:-.p Regiister Narnber
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11,18-iinal
Date
3 - 2. t 1- --..-le•.ery or Cremator .
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remon (ke--(- )S\DJ Ylj Npiry,c_.Date , .creed
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Date FU 1 a ;i1
S hi pment
Cemetery Address
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Date Cemetery Address 1
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Perm4 Isiand to Registration Number 1
Name or Funeral Home B r-tuo-e_r- .- ..nc_ra.,t no rnci )n c _ 0 D(9-1 1
Addiess
0.ht,urc,h $t Lot)(e_ /,,IA:7--e,-r-rt_e_ n) y ca,,,, ,, ,;brieral Firm treittlidrig 1..)ispos.:tion or to '4,."..11(j,-I
I- Remains are Shipped i' Other thin Adni,...e
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a.f Permission is hereby granted to dispose of the human ain des.--cribed ova as indicated. 4
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I Date Issued 63-/o ,._/tit Registrar of V,tal Statistics
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41istrir1 Number 53-3 r-iac. 6-2,,,,,, _ --)
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i et-trilly that trun, romans :If the dot:Pi:low laeritried ilLOVP were disclosed di in accord.ancle with this permit on.
Ili Date cit 0:i:4)1_151th-A 31)--/V Flacli_. ar D6clia.5.11:ii ii,fre- (.4(...1./
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0 Name o Sextor-/ r .:ir n in harde :1 Prerrtses
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