Merritt E MorseBUREAU OF VI'r�NT ®F �IEAET�I
L sTATISTICS
STATE DEPARTMENT
NEBxASIA ® 0052
PER IT N-
DISINTERMENT ermission has been granted to
Application has been made and p _,,,..of
FreC1riCk. Axnan
...........................
.............................
Supervising Funeral Director F_ 68008
Blair...........................................
Cam bell Buueral �i®me, .....................
.............
the...•-•••"" are of Firm and Address
I�iorSe ...............................
to disinter the (body) ............................................... ..._•.•...,..•...
...................I.........
................................................. or town of
.................................... in the city
Blair ........ cemetery
tgjl , Nebraska, to be removed
now buried in the ............................ WaShi_t9g............
Blair ................I county of ................ Blair .......................................
..................
P/C .... to .......................
............. of
by .................... Blair............., county
cemetery
in the city or town of .............
.....N.eb.r.aa
..................................................... state of ...... THE
REBY At THIS VD SI STATUTE 71-605.
PURSUANT TO
I xE 4197
PROVISIONS OF NEBRASKA R � � � 2
"'j. &V ...... ........
...................
Date
.•(signature)
DIRECTOR, BUREAU OF VITAL STATISTICS
DEPARTMENT OF HEALTH
• hould be retained by the cemetery where the disinterment takes place.
This permit s