Peter Paul Thompsonw
Blair Cemetery"XXX
Omaha, Nebraska
Permit for Interment
Complete the Following
Number
Peter Paul Thom son
Name of Deceased
7-- 6--
12-3-09
Age
Date of Birth
NE
Home Address
Place of Death
Single, Married or Widowed M rried
White
Race
Pendin
Cause of Death
1-25-86
Date of Death
1-28-86
Date of Interment
Effi Thom
son
Nearest Relative
In Whose Lot Interred
Grave ------
Lot ----- —Section
Box
Tent �—
Vault
Relation to Lot Owner;
OF FUNERAL DIRECTOR
SIGNATURE
I hereby authorize the interment of
in the lot and grave space designated above.
Signature of Relative or
Legal Representative _