VanDyck, Roxa ''..;Li,r.,•—•{Cf- :. ''..-7.,T ATE C-E PA,rrT.1 EN' i:.-,F.- i 1 E.•iti,if 1-1 IL ,
Vital 7--tecords b'err lion Burial - Transit Permit
0 X CA. A an 12 .11 bc K 1
• rc-rAct V- :
aa1t ,i:ki:.
-aa-c.401 it virticir a I. K rt f.:t 1 .S. rat ForC-5.
1— Pla2e ':1 Deatri -,,,:Lifirol lrNtiti„irnt
or Vi101)-Tr g Vn3 P6k,i(s Street Add \s ress
lUi cd 4.)ricti
,D klartricir r:4 1111°-1 rc:li,m Natilha' Cal isi-, r 1 rck i -hi- El Hrrnicide IT.] Suicide r-1 Urintelermtned 0 Pending
U (7.:ir:71;mstaric:r!..s invti•Mtgation
1
ILLI Vi...:.1,::„: ll C:',.--titrrr l',J,Iirr,. Title
CI ''ItSt\I 1 CI 0.A.A-V\n e\c \f\O...i," A\-A
Dealt' GE...MIK:Lite Firec. , r---. Dit)tit Nii. # P.L-ri.jr:,r t i-ir- ..t
5cDA
B :t
ra or r.,.rernatooa
i
Di tirminiri o 4 Do 13 i
xY\Cd0 rA
K:rerrialion P UZSLA(1..5 b u.rk_ NI
Dar.,,, -1, ,--.,:, 7,,r,•mk.,,,,,T7,0
7-1{4.71c-tVili il!PLI Of 1 krid
if
(...11--!ait-rt,.-r-
,.....1 hejle,1
In_
0 atte hi..; HI
1:1- -- Ti ri-i= -,--t-ho-- '3i-up-writ
.,, ,.,,i,,,,, 0., ,
15 Oy LA-...111;11;LAA r3C:0,.;•:Hii,ili2n
Carrier
Tsrate r:enrietEHy Address
7;Fill' Crimeteni Address
,.,El
P•ritrri t IF.F.:iod to Registration Num trer'
Name. or F une'ral FlOirst:131-CAAXA-- fA-ne-}ir- 6 V---\--to ri- e-i 1 V1C- • .
_ ....... .
Addri,.rtis
celf- Ukk.'iCk Si' Lk iL 1--LczYlk f\.) -.( ) q Co
' Nirxr-,e GI F rine;al F it tti fi,litki'ig Di...Aro...Ali:in oi lo iltritry-i
— Rer-,ains are Shipped it Cities than Art ttve.
2 AG,J7E.'.i.S
re,
Lii,
.:
a' Permission is hereby7 anted to dispose of the human remains de crib ti ov s &toted
Dat .
/
e Isisuec 6,7 oifi .2..at-7 F4.eflistrar oi \Pia! :Elirtstics
,
•, :.... ,irt Ni.int.4.2f
i r.oriih: that rhr, contains r:f tivi dtric.,ndor-ir idrinrit r,..I ili:_ay......4. ......4:.-nia :iis,vosEu :11 in Oecoruanue with this permit on
Z
E.:07.•,, 1.,:di. O rr,pir sitioil clu cit) Flai rrr r.1' it, li.D :i,ft„tlii.1 ''?aU ., C
LU CP04171r sle..—
III
CC; ,,t'Ave --,..,mbe•,
in Nestri.-2 o" Sexton cr 7-',:.-.1sor, in C. =lige r.-.1 Prem_Hs litiiices-i St^-44
iature,
----- 1-- 7itie 62CMPT:Ort. ... .
. ..;
2.0H-1 SS''S F:‘,2,•20i2-41