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VITAL RECORDS SECTION IOWA STATE DEPARTMENT OF HEALTH
BURIAL -TRANSIT
Full Name of Deceased --- � t' J___ROBERT BENNETT_ B1`,ILEX__________________________________________.
Place of Death ----------------------- Tabor ------------------ prem t-------------------haw&---------
(Town or City) (County) (State)
Date of DeathApr_j_j_2$t_ `i_9Q8_______________, 19____ Color_Whi ____ Sex -Male .--___ Age___.63____
Cause of Death --------- Natur&l--C s--------------------------------------------------------------
Method of Disposal ----- Eur'jAl--------------------------------------- .B.r _ZeMP_te-------
(Burial, Cremation, Transportation, etc.) (Cemetery or L_nm tory)
Town--Ba11Y'-------------------------- County- Xashin n----------------- State_Nebmaska--------
A Certificate of death having been filed as required by laws of this state, permission is hereby given to
Funeral Director:
G am#'-o.rR- -as- r -&tai -1- raal-Hom6ddress--- T'-abar°,- Z® -----------------------------
(Name)
i
to dispose of body of said deceased as above stated.; % t
Signature_ _- i fm-=----------------
-f; (Registrar)
Date__Ap2zi30--thi------------- 19-M AddressS1.dn t_ W.& ---------------------------------
(City or Town and County)
CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SPACE BELOW
Body was---huri-ed--------------- on__M 2_nd t , 19_88, (Whether Cremated, Buried, Etc.) (Cemetery or Crematory)
Located at_ Rl a t_Xebmaska____--____ Signature_____________
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I SEE OTHER SIDE I (Sexton or Person in Charge)
This permit must be endorsed by the sexton (or by the Funeral Director where there is no sexton) and
returned to the registrar within 10 days. Form V. S. No. 9
Sxn-009-3i79