Edith May NelsonCOLORADO DEPARTMENT OF HEALTH
0 AUTHORITY FOR FINAL DISPOSITION
This final disposition permit, when completely filled out and bearing the required signature, constitutes
authority for burial, interment, cremation, removal from the state, or other authorized disposition of the
deceased named below, in accordance with Section 25-2-111 C.R.S. 1982. This permit must accompany
the remains to their destination.
Name of Decedent Edith May NELSON Date of death 06/26/1997
Sex F Age 93 Date of birth 07/03/1903 Place of Death � rush Morgan
City
Name of Funeral Establishment Heer Mortuary
Address of Funeral Establishment 222 Cameron Street Brush Co 80723
Type of Disposition Burial Place Blair Cemetery Blair NE
Cemetery or Crematory City State
ave examined the completed death certificate for the decedent named above and authorize finai'dis-
0he
tion f the remains. (To be signed by the office designated or established pursuant to Section 25-2-
C. . 1982 in the county where the death occurred, or if such an office does not exist in the county
re death occurred by the coroner or the coroner's designate.)
NE Colorado Health Dept.
228 W Railroad, FT. Morgans CO 6/26 97
Signature, Title Address 80723 Date
Items below are to be completed by the cemetery or crematory official.
Where there is no full-time person in charge of the cemetery, the funeral director may sign as sexton.
Body was .�4r8 L�yr'f r cl Date ��� In Lot L Block / a-7 Section G/: j o
Place e) t C< i v, Q_ a t ---e �+: � y !� �- ci t" r� LAI-.
RIA
Signature, Title
7-3- '7 7
Date
N
COLORADO DEPARTMENT OF HEALTH
.0 AUTHORITY FOR FINAL DISPOSITION
This final disposition permit, when completely filled out and bearing the required signature, constitutes
authority for burial, interment, cremation, removal from the state, or other authorized disposition of the
deceased named below, in accordance with Section 25-2-111 C.R.S. 1982. This permit must accompany
the remains to their destination.
Name of Decedent Edith May NELSON Date of death 06/26/1997
Sex F Age 93 Date of birth 07/03/1903 Place of Death Brush Morgan
City County
Name of Funeral Establishment Heer Mortuary
Address of Funeral Establishment 222 Cameron Street Brush CO 80723
Type of Disposition Burial Place Blair Cemetery Blair NE
Cemetery or Crematory City State
rhave examined -the completed death certificate for the decedent named above and authorize final dis-
.1 p 'sition f the remains. (To be signed by the office designated or established pursuant to Section 25-2-
1P3 C. . . 1982 in the county where the death occurred, or if such an office does not exist in the county
yvhere death occurred by the coroner or the coroner's designate.)
NE Colorado Health Dept.
228 W Railroad"- FT. Morgan, GO 6/26/97
Signature, Title Address 80723 Date
Items below are to be completed by the cemetery or crematory official.
Where there is no full-time person in charge of the cemetery, the funeral director may sign as sexton.
Body was �� �� Date In Lot 12 Block J D-7 Section G1, j D
Place f3 ) a ' V" C— -Tle, L SLG ," t'� V 2 hr -
Signature, Title Date