George Ray CooperBUREAU OF VITAL STATISTICS
STATE DEPARTMENT OF HEALTH
LINCOLN, NEBRASKA
DISINTERMENT PERMIT No
Application has been made and permission has been granted to
.... James .... .....Moser...............................................................................................of
Supervising Funeral Director
the... Moser Memorial Chapel,._ 2170. N_. Somersp Fremont,
NE 68025 Name of Firm and Address
Cooper III
to disinter the (body){ 8 s ..... George Ray ..
.........I....
................................................................................................................................................
now buried in the ..... Bla...........i...r .... Cit
......... Y........................ cemetery In the city or town of
Blair county of --..Washington Nebraska, to beremoved
by....... R.c ................................................... to...Ridg.e....................................................
cemetery in the city or town of ......Fremont county of ,Dodge ......
..., state of ... Nebraska.........__.....................................................
I HEREBY AUTHORIZE THIS DISINTERMENT PURSUANT TO THE
PROVISION OF NEB ISED STATUTE 71-605.
....................................... .
....SEP -22;1995
. .. 2; ® ........
(Si ature) -
DIRECTOR, BUREAU OF VITAL STATISTICS
DEPARTMENT OF HEALTH
This permit should be retained by the cemetery where the disinterment takes place.