Kermit Edward UpchurchKermit Edward Upchurch
We Certify that
(Name of Deceased)
Who Died on the day of Who 200-4
Was cremated at SOUTHERN CREMATORY, San Mateo, Florida, on the
9th day of March 200 4
Permit No. 112-2004 CrematoryNo. 011
Eternity Funeral Home
Name of Funeral Directors
SOUTHERN CREMATORY, INC.
720 Highway 17 South P.O. Box 939
`1 San Mateo, Florida 32187-0939
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By: