Boyd E WoodVS 302 (7/84) (This notification is to be used
MISSOURI only when deemed necessary
by Funeral Home Licensee)
OUT-OF-STATE DISPOSITION NOTIFICATION
Effective August 13, 1984, the State of Missouri no longer requires the acquisition of a
permit prior to disposition of a dead body. Authorization for disposition is acquired through
notification of death to the Local Registrar in the county which the death occurred.
Section 193.175, RSMo. (Supp. 1984)
1 hereby certify that notification of death for
(decedent)....-. ••Ql.:,` .....,..... ��........................................................................was filed with
the Local Registrar of ��t-� �a?....•.•••.........•..•...............................•County, Missouri on
(date)........ ".. f A,......
°°°°°R SIGNED c , r f..
`neral Home' Licensee1/4
License No. i