Louis R. MurdochMONTANA DEPARTMENT OF
HEALTH AND ENVIRONMENTAL SCIENCES
Vital Records and Statistics Bureau
Cogswell Building, 1400 Broadway, Helena, MT 59620-0901
AUTHORIZATION
FOR REMOVAL, TRANSPORTATION AND FINAL DISPOSITION OF A DEAD BODY
ORIGINAL TO ❑ ONE COPY TO ❑ ONE COPY TO MORTUARY/PERSON" ❑ ONE "COPY, To"CEMETERY/CREMATORY
Local Registrar Coroner IN CHARGE OF DISPOSITION „ OR TO ACCOMPANY REMAINS OUT -0F STATE
Machine or Facsimile copies of this form shall be valid for all purposes
1f fetal death, dheck this box: C1 and provide datafor mother orfetus
as aWopriate
NAME: LOUIS R. MURDOCH DATE OF BIRTH: _,TUNE 11. 1406
SOCIAL SECURITY NUMBER: 506-03-8949 ( Male ❑ Female
DIED (or was found) ON: JULY 5 1995 2:30 AM -
date and time
AT: BOZEMAN DEACONESS HOSPITAL
name of institution, address, location of death or discovery as best described, including city or town
IN GALLATIN
COUNTY.
- - - city
state zip
cremation Authorization:
coroner's st" nature date si ned
CEMETERY OR CREMATORY AUTHORITY MAY COMPLETE
JULY 8, 1995 BLAIR CEMETERY
date of disposition cemetery or crematory name ®buri ❑ cremated
BLAIR WASHINGTON NE
:ity of disposition county state sexton or person in char e
1 tD