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AUTHORIZATION FOR INTERMENT
To BLAIR;,CEMETERY
BLAIR, NEBRASKA
You are hereby authorized and directed, subject to the Rules and Regulations
of BLAIR CEMETERY to inter the remains of:
Name of deceased LAURITS J. KJOL
Late address 2230 JONES ST.
OMAHA NE. 68105
Social state ti3IDOWED
Age 84
Section
lot space
Date of birth March 22, 1903
Date of death August 7, 1987
8-14-1987 Cause
of Death Pending Coroners Sign.
Interment date
NONE
Nearest relative
Address
Telephone number
Relatior>,s;hip
Signature of Funeral Director"
I hereby represent that I have the legal
right to make this authorization, and I
,from any liability
agreeto hold BLAIR CEMETERY
on account of said authorization and interment.
Date
Signature of lot owner or his
representative
Acct. No. —
Price of lot _
Service —
Vault -Dome
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Addross State Zip Code
Final date
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