Marie R Edwards`Lb
BLAIR CEMETERY
Blair -., Nebraska
Permit for Interment
Complete the Following
Number
Name of Deceased
Marie R. Edwards 81
2 2 190 7 Age ------
Date of Birth June Omaha , Ne .
Home Address 801 So. 52nd Street,
Place of Death maha Nebraska
Widowed
Single, Married or Widowed
Race White
Cause of Death
Date of Death D -C. 7 1988
Date of Interment Dec. 9, 1988
Nearest Relative
Donna L. Clark- Daughter
In Whose Lot Interred
Lot 12 Section 65
lock Grave �_
Vault
Monticello Box
Relation
— ---
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