Parish, Harold St 4, 3
‘iii.E.Vit. VORA:. rr-T;TATE CEPAPTt.if Li:NJ* Or: HEAL-H 41 , , 11
"At c.rds 13erziliur. Burial - Transit Permit
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:late Cemetery Address
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.7/K1p Cemetery Address
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i-fi Reirrains are Shipped if puler rh-Fig Arliflidif.:
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_ Permission is hereby granted to dispose of the human remains described above as indicated_
Dale Issuer', /‘) iyidd . Regis-for oi 'iLtari L'idli:siticri/
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' r:orlIfy :Oar !he-, I 1,171al IS i.ri.f ac rincir!don- ',tni en ed iiritiLiiie. % ere rastras en :.11 in accordance with thm permit on .
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ick INi.trili," ''_14 Si.ixtor er :7-4.-rrson in Charge :-.I irI2 rri.Ii Ei'S
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7,'OH-155.5 :32 20,2,41