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Darrah, Thomas 0 1 4 S(or ...,,c....--vv. YCPA F_CYATE DEPAPrrt.-IEN Or: tlEAL71-1. - Viial 7-7r.P.,:xlds Se,:_rlitir; 0- . Burial - Transit Permit _ ....., .....r .:ii,- iii:,-,t Sex 1.1.\DVV10.5 A -bar r a K . Ma),C, 17 Lla t., ot 1,9ariti Aot.? 11 .14-21(lati Ct 0,5 Arrn(Hi 17-irr.f..--5, Nr. ',.n LJats ---, Flac.e rzl Death -.tulintal IrNtr!..ltrk•:: or , 1 i ,E!crli.; VOie G k_4(ls --.1--c-A. (s a -1 Aadress S --.a lk,S\--\--of tick ( ILI' 1 Ace:1,7k," ri He.,„renej-i„ EJ silicid,?_ 1-...-L-Li Undetermined 0 Pending 1:11 ‘ atirl 'r d r..)'''''11:1- K1 Nati.41! :-.::i112F,r. . .. ,1.1.1 L ,, ...,„_ C,;i1n7.1,,m-o-..tanc.es 1 rnfil•Fi.tig Mon tuj kik....,,I.::011::::ur.ltic-t Nai---1.. Tale , tni MON-CIAULY k c'e. .' k\ ((x\-ik 0 mi) G 0.-ran Ceti:III:J.11,i? Fri,..C1i--.) 011.1c1. N:irriLle. i.-1.u.r4;t:,1.C'i N..irr;40 11,(f,„74:- Tot,vn or VIiirf' 1.77,14 f----\S ......7.. a .., --i-r, -- - a r1 r.._.:rr11:ery or rematow LJEtaril 0 a9 - LI - 13 r)e. te),0 DL rif:wihn iHrt ..„, , . Z1 ti.74,F, t><C f ern alicti et)af2--e7A/ b Lk_["—1 (\I' y ..) t.i.,, Pi._-. , rii-mc,..(? 1 1 :-1.€,-71(.+Vili ititd.Of i Feld , __ ' — —C11-1 ar•-. ,or 4c,-..rdrri,.:.ir.; 1.---' .071 0 Dote F...:-.111 Tir-c 1.- t-r-n ;1,, no;,Jr cio, r 3 tli Rnerit b"' 1);), 0•orr;ill ori DE.-s:iniiii2!I .7.:Fuript. 711tr, Cemfftery Andress , - am, Cernetery A•adtess r—i.• i r-R.2 '114-Jr III k:I.7'. !, _ i R711)).f 1 S5,.100. to Registration Nurnbe, aN nni:.--,101 i---unral Hoitc:.;, it_u3-e,,r -rIRJAQKOL, 1-1VvyLit..... 1 L. OO t I Addi,...,:s r a-Aikr-c_1,\, 5-t„ LeA,tc_9_ Lii-zeJr-m \\) ( )2,84.C Nar-,o ot F one r al 'irril NA Lthrig ..)1.4m...yr,rtiors. LI! ICI .,,,%11:11-1 1 .• _Rerrains are Shippe.r1 If athr tn.r1 .4.1-1:1,.;;.e cr) CL Permission is hereby granted to dispose of the human remains describe a dive ndicated. i 1 I Date lEsl-rec1 1!%17/020/.3 Regis:rill ol V Stilt,sucri A - e•-i;:4' ,, , ::islort Norni)o, .5-60/ r-11;1•=.74-• ret.s.<7 h,"--A . 1 ,-..r i i f, t ...,,,,-. mth_ff.,...L:iii-„,-,... ..ve,..„.ns.......i.. „..lir., ...,,iieec,,.. thisi..k;vorri:on Z / . ___ .-2...-•,:riit,...,;,,ith 1,111 Da".o of D-'St OS ItiOn 1(Z4113 "citr'-' `7.1- DIt.:),1!•.,,!::-1 -tick„ cfrp4or nft- 2.: ...,......t...,:,., u.i,... cni cc; ..4,,,,,,,, t: ..,...,-,.,...„,....., .,'.g",l'it..4.M.i:rtxe'l 01 Lc%a4t i ;C:11 No.ap,.. ,...14 Stor; cr E:,1-r--..or- in Charge r.: rer-r-LHos Lii • -l'IL' Cgill^KatC— S.;patur-,,,? ' ; • - , ... . . ., , .. .... -,......, . _ __ ... . • r',.:Iver,1 7:-OH-155-3 :-.22 2004i