Shirley MooreSTATE OF NEBRASKA
DEPARTMENT OF HEALTH
Bureau of Vital Statistics
This permit, when completely filled out and bearing the required signature, constitutes authority
for transit or cremation of the deceased named below, in accordance with Section 71-605 R.R.S.
of Nebraska.
Name of Decedent Shirley Moore
Date of Death July 29, 1986 Place of Death
Sex F. Age 59 Date of Birth March 17, 1929
Omaha, Nebraska
Name and Address of Funeral
Directing Establishment Boyd E. Braman Mortuary, Omaha, Nebraska
Type of Disposition: Transit XX
Place of Disposition Blair Cemetery
(City and State)
Cremation
Blair, Nebraska
(Crematory)
I HAVE EXAMINED THE COMPLETED CERTIFICATE OF DEATH FOR THE DECEDENT NAMED
ABOVE AND AUTHORIZE CREMATION OF THE REMAINS. (TO BE SIGNED BY THE COUNTY
ATTORNEY OF THE COUNTY IN WHICH THE DEATH OCCURRED OR HIS/HER DESIGNATED
REPRESENTATIVE PURSUANT TO SECTION 71-605 (Paragraph 4) R.R.S. of NEBRASKA.
(Signature and Title)
(Date)
Items below are to be completed by the funeral director in cases of transit and by the crematory
official if remains are to be cremated. Method of Disposition:
❑ Cremation
(gnature of crem tory representative) (Date)
(Transit F 8/1/86
(Signature of funeral director) (Date)
Distribution of copies:
For cremation — original retained by crematory; copy to County Attorney
For transit — original accompanies body; copy to be retained by Funeral Director
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