John J MeyerBLAIR
CEMETERY
Nebraska
Permit for Interment
Complete the Following
Number
Name of Deceased John J. Meyer
Date of Birth 11-10-1890 Age 96
Home Address 741 2 North 41 S;kr-eet
Place of Death Omaha, NE
Single, Married or Widowed Widowed
Race klbit: P
Cause of Death Fending
Date of Death November 2, 197
Date of Interment nrim ea bbe-- 4 1987
Nearest Relative Donna Smith - Granddaughter
In Whose Lot Interred
Lot Section Grave
vault Box Tent
Relation to Lot Owner
SIGNATURE OF FUNERAL DIRECTOR
I hereby authorize the interment of
in the lot and grave space designated above.
Signature of Relative or
Legal Representative
11