Roy Claus BuschBLAIR CEMETERY
Omaha, Nebraska
Permit for Interment
Complete the Following
Number
Name of Deceased Roy Claus Busch
Date of Birth November 3, 1901 _Age 91
22i_,2 NE 68102
Home Address —
Place of Death Omaha, Nebraska
Single, Married or Widowed Widowed
Race White
Cause of Death
Date of Death August 1, 1993
Date of Interment August 7, 1993
Nearest Relative Lorraine Kennedy (Mrs. Victor)
In Whose Lot Interred
Lot
13 Section Block 66 Grave #7
Vault Box Wilbert Tent Yes
Relation to Lot Owner
SIGNATURE OF FUNERAL DIRECTOR'S""
KREMER FUNERAL HOME
I hereby authorize the interment of
in the lot and grave space designated above.
Signature of Relative or
Legal Representative —