June M JohnsonBlair, Nebraska
Permit for Interment
Complete the Following
Number
Name of Deceased:
June M. Johnson
Date of Birth:
June 1, 1922 Age 73
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Home Address:
6363 Grover 4100 -
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Place of Death:
Omaha, Nebraska
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Marital Status:
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widowed
Race:
White --------------------------
Cause of Death:
Pending
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Date of Death:
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March 4, 1996
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Date of Interment:
March 7, 1996
Nearest Relative:
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Robert L. Drummond
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Vault: Vaulcoa Concrete Box Box: Tent:
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SIGNATURE OF DIRECTORJon B. Roeder
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I hereby authorize the interment of
June M. Johnson
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in the lot and grave space designated above
Signature of Relative or
Legal Representive:
Brother: Robert L. Drummond
Address: 9041 North Park Road
city,state: Rogers, AR 72756
Phone: (501) 925-1923