Alfred Joseph JaenikeMb
FOREST LAWN CREMATORY
P, 0. Box 12006, Florence Station
Omaha, Nebraska
Permit for Cremation
Complete the Following
7730
Number 68606
Name of Deceased _ L rf c �Is
Date of Birth1ge
Home Address
Place of Death i v
Single, Married or Wiidow/ed/ S a "/j /P Race C_'j
Cause of Death
Date of Death
Date of Cremation err
Nearest Relative A1_zS_5e4 ( % �G
N
REMAINS MUST BE IN SOME FORM OF A CONTAINER
Cremation No. 7 30
The undersigned authorizes FOREST LAWN CREMATORY to cremate the remains of
/91 �• _
following disposition of thecremains be made: and further authorizes that the
*Ship to —. t/ ri ki2 �i3c�l/ `cp ✓Pr0 � /fir ,, � .
rGSIea G j -fl c
❑ Interment or Inurnment at Forest Lawn Cemetery
(Description of Property)
❑ Hold for further instructions. (If held longer than 10 days, a storage fee will be charged)
❑ Release to
I hereby certify that I am related to the deceased as
and that I have the right to authorize this cremation and determine the disposition of the
cremated remains: that any personal possessions have either been removed or may be de-
stroyed: and that the body contains no Heart Pacemaker. I further agree that I will indemnify
and hold harmless the crematory from any claims to the contrary including all liability and
claims related t the ship t f t e se �m�ains.
Signed ���� _7C �1 ., 1._ ....
Address tZD AI /,j0 '4 r ✓ .l —
Witness�--"
SignatU a of F
N0 5a32�1
BIJRIAIjTRANSITICREMATION PERMIT
...........
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Name
place of death ... • Blair ®
Ch
Date of death......... nae
37 Sex
ire Age............
Color
Cause of death
®n
Method of disposal . , ......
•F'OreSt La •
Cemetery, etc. • • • • '' ' • • • ,
ploel� .
Mortuary ................Blair
........ • ® �
lair ® deb . . ..
14
ar
Address ............ • • 98
Date issued ........ ..........
•` - or evaty)
. ,�... • � istrar i,
Sr .. • ' �CountY ReB
gVS.R•25 �II
Rev, 2-1982