Arthur Christian LorenzenBlair Cemetery
Blair, Nebraska
Permit for Interment
Complete the Following
Number
I hereby authorize the interment of
Arthur Christian Lorenzen - _
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in the lot and grave space designated above
Signature of Relative or
Legal Representive:
Son: Gary R- Lorenzen
Address: 15028 Atlas Plaza
City,State. Omaha, NE 68137
Phone: (402) 896-8059
Arthur Christian. Lorenzen - - - - - -
Name of Deceased:
- - - - - 88
March 6 1907 A9 - - -
Date of Birth:
- - _ - ------------
5318 N. 62nd Street ------------ _ _ -
Home Address:
- - - - - - - ---
pmaha, Nebraska - _ _ - - " -
Place of Death:
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Widowed
Marital Status:
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White
Race: -
---- - - - - --
CauseofDeath:
_en -- ----------" -----
May 30, 1995 _ _
Date of Death:
_ _
June 2, 1995
Date of Interment:
--- - - - - - - ---------------
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Gary RLorenzen ---------------------
Nearest Relative:
-
Block 46 Lot 91 Grave #12 _ - _ _ _ -
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Vaulcoa
Tent:
Concrete Box Box: _ _ - - - - -
Vault:
--
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Brad B.Brodhagen
SIGNATURE OF
DIRECTOR: - ------
I hereby authorize the interment of
Arthur Christian Lorenzen - _
------------
-----------------------
in the lot and grave space designated above
Signature of Relative or
Legal Representive:
Son: Gary R- Lorenzen
Address: 15028 Atlas Plaza
City,State. Omaha, NE 68137
Phone: (402) 896-8059