Dorothy M. CleaverZ
O
Q
N
FE
O
2
Q
STATE OF NEBRASKA
DEPARTMENT OF HEALTH
Bureau of Vital Statistics
Permit for Transit or Cremation
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 Dorothy M. Cleaver
Date of Death May 24, 1986 Place of Death OmAha, Nebr.
Sex F- Age 65
DateofBirth May 12, 1923
Name and Address of Funeral
Directing Establishment Bo
Type of Disposition: Transit X
E. Braman Mortuary 1702 N. 72nd Str. Omaha, Nebr.
Place of Disposition Blair, Nebr.
(City and State)
Cremation
Blair Cemetery
(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
k Transit
(Signature of crematory representative)
(Signature of funeral director)
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
(Date)
(Date)