Laverne J Williams2
.,MISSOURI DEPARTMENT
OF
BUREAU OF • -
OUT-OF-STATE DISPOSITION NOTIFICATION/AUTHORIZATION
This notification is to be used only when deemed necessary by Funeral Home Licensee.
The State of Missouri no longer requires the acquisition of a permit prior to disposition of a dead body, effective August 13,
1984. Authorization for disposition is acquired through notification of death to the Local Registrar in the county which the
death occurred.
Section 193.175, RSMo (1986)
1 HEREBY CERTIFY THAT NOTIFICATION OF DEATH FOR
DECEDENT
LaVERNE J. WILLIAMS
WAS FILED WITH THE LOCAL REGISTRAR OF
COUNTY
DATE FILED BY LOCAL REGISTRAR (MONTH, DAY, YEAR)
Greene MISSOURI ON
November 17, 1994
CEMETERY OR CREMATORY - NAME
LOCATION (CITY, STATE)
DATE (MONTH, DAY, YEAR)
Blair City Cemetery
Blair, Nebraska
November 19, 1994
SIGNA NERAL HOME LICENSEE / T
MO. LICENSE NUMBER
usanne M. McLaughlin FD
MO 6562
MU baU-d-l27 0-92) A EOU E OPPO UNITY/AFFIRMATIVE ACTION EMPLOYER - services provided on a nondiscriminatory basis VS -302 (10-92)
Whelchel F ner l Chapel, Branson, MO 65616