Goodsell, Emmett .=ex t ys.r ?. }mod "^les9ic, '."'�':lc;.`4+o-.w.' ....4. 4. .•-. +y "" y.',ZZ>, '" .-y'-r +raa'
A+ wY ia k Y ifi `. !► Y i w b z; Sirr s ;. .
_ ♦ 4
•
- ..
• Name ,L'iM ,JLl 77 _ — 57
�� ,� c�D �/� lase Number
xS
Date of Cremation F:_---/` 7
Time Cremation Sfarted t o� i• A4 f _ ____
•
.z
t7/m ,
Time Cremation Completed
/d ___�____;
Type of container CXe /lt- r',/ S ,_
, temarks ,!V� r �� �/f'
/ ( II : / R. I° ,_
11 /1 3 , a , );3.
! / " i f I
•
/1II • ' !,
,Z121,______________________ • .- ..... .
_l / /1____ c /}'1)
i
l'I 1 i _ 2' ,, f
.j-_/ i /i
r t
r �.a#e.*�'�, .,raw a'',a'.t.,,, ` ., .} nf.
a � ,�
r ..�a x 9" r a g ..- z
'.,G �