Susan Jean CharetteBUREAU OF VITAL STATISTICS
STATE DEPARTMENT OF HEALTH
LINCOLN, NEBRASKA
DISINTERMENT PERMIT No
Application has been made and permission has been granted to
Fredrick J. Aman,
............................................................................................................................................ of
Supervising Funeral Director
the ... ampbell-Aman...F.unc.z.al...T1ci.me.,...A4.4....S.ou.th....11 th....S.T..
Blair NE 68008 Name of Firm and Address
to disinter the (body) (16 ) ....... ausan... ean.. Char e.t.te..............................
................................................................................................................................................
now buried in the ...... B A :...................................... cemetery in the city or town of
.....Blair .................... county of .....W.P,.bing:t9n..... Nebraska, to be removed
by.........R �................................................. to ........ laix............................................
cemetery in the city or town of ...........)3.j ajx.......... county of ...Washington..
........................................ state of ........ ...N.ebraska.............................
I HEREBY AUTHORIZE THIS DISINTERMENT PURSUANT TO THE
PROVISIONS OF NEBRASKA REVISED STATUTE 71-605.
0 ... ... 4.DEC 0 41995
_ ................................... .....................D -at ........... .
(Signature) Dato
DIRECTOR, BUREAU OF VITAL STATISTICS
DEPARTMENT OF HEALTH
This permit should be retained by the cemetery where the disinterment takes place.