Gregory L Osburn. JUM 16 1979
BUREAU OF VITAL STATISTICS
STATE DEPARTMENT OF HEALTH
LINCOLN, NEBRASKA
DISINTERMENT PERMIT N? -1614
Application nas been made and permission has been granted to
._F_T_edrj__ck__Aman I ----------- -of
Supervising Funeral Director
the ---- Campbell Funeral Home, Blair, NE 68008
------------------ ----------------------------------- --- - ------ - _ -----------------
Name of Mrm and Address
to disinter the body of --- Paul --- Hax 014-Jo.r. ge_nsem ------------- --------------
now buried in the. --.Blair _ ----- cemetery in the
- ..: ----------------------- ----------------
city or town of --------pl-a-i-- r --------------------, county of ...... jyqsbi Qton---
---
Nebraska, to be removed by__ ---P/C ------- to
-1 ------------------- ------------- ---------
Blair ----------------------- cemetery in the city or town of
-9 -f a-- I -rWashi ton
------------------------- ------- I --------- county of------ --------------- Washington---- ---------------
state of --- .._N_eb_r-as.k-a_ ------------------- This permit will take effect upon
approval of the local board of health at the city of disinterment.
Nothing herein shall be deemed as contravening or modifying to the
regulations of the Department of Health governing the transportation
of corpse or the requirements for transportation permit. All trans-
portation companies andmon carrier b governed accord-
ingly. �T
------------- - -------------------------- --------------------------------------
Director, Bureau of Vital Statistics
The foregoing application for disinterment and removal is hereby ap-
pro7d by the Local Board of Health of the city or town of
a , this.-' . ay of--
19
-------- Ne
-
---------
- - ---- --- -- -- ------------ - ----------
Chairman, al o -d of Health
(If a City or Town)
(Affix Corporate Seal)
Attest------------------------------------- ----------------------------------------------------------
Secretary, Local Board of Health
This permit should be retained by the cemetery where the disinter-
ment takes place.