Kenneth Kuhr9
TEXAS DEPARTMENT OF HEALTH PERMIT
BUREAU OF VITAL STATISTICS BURIAL -TRANSIT PERMIT NUMBER
1. Full nome.of deceased 2. Date ofdooth(month, dap® and your) 13. Death due to
'PERSONAL Icommunicable YES
disease s®O DATA ON
DECEASED
4. Sex
S. Color or race
6. Age In years
A.- (city or precinct no.) (county) (stat®)
7. Ince of death
/3-
Method of Burial Cremation®
1:1
Place burial (name oViametery cW ce rrud6rium) (Cltyo;-town) (state)
MANNER AND
disposal Removal �- Disinterment®
removal or
disposal
PLACE OF
Name uperalAirector
License number
Business address
DISPOSAL
Name of ernbc�mer TI(none® wrte none)
License number
Business address
/4
A certif-caft of death having been filed as required by the laws of Texas and all laws and regulations governing the preparation and
1 AUTHORIZA'
TION TO
disposal of dead bodies having been complied with, permission is hereby given to dispose of the body as identified above.
DISPOSE OF
Signatuis of 10
District (city or precinct no. (county)
Date
BODY
uft N.
Body was Data
Name of cemetery
DISPOSITION
Buried
L/ f
OF BODY
Location (city or town) (county) (state)
Nomeof'sexton or person in charge
Cremated F] I 6e
i"5
7-