Carl H NielsenI
STATE OF SOUTH DAKOTAatG
DEPARTMENT OF HEALTH PERMIT NO. 6-32
PERMIT FOR ISP ITIO OF DEAD HUMAN BODY:
DECEASED-NAMEFIRST -MIDDLE LAST .SEX DATE OF DEATH (MONTH, DAY, YEAR)
Card, Niel Male 10, 1996
AGE (YRS) PLACE OF DEATCOUNTY CITY, TOWN OR TWP. U.S. WAR VETERAN
7 Sacred Heart Hospital Yankton Yankton .,,,,(YES/NO)
DISPOSITION AUTHORIZED:: ; F] INTERMENT lidTRANSIT C,I DISINTERMENT
2 '- AND REINTERMENT
O j Ej CREMATION E] SCIENTIFIC STUDY
QZ ! PLACE OF DISPOSITION (NAME AND LOCATION OF CEMETERY, CREMATORY OR LABORATORY)
h
W Blair Cemetery Blair Ne
a PLACE OF DISINTERMENT (NAME AND LOCATION)
O
t -
O;
O THIS PERMIT IS ISSUED TO:. r
Q.EY.stel Funeral Rome FUNERAL DIRECTOR S.D. LICENSE NO. '1106 1
a
o P.O. Box 342 Yankton, South Dakota
O ADDRESS:
DATE:.3 Z(SIGNED) ,, v' --'�" REGISTRAR
REGISTRATION
Yankton � P.O. Bax 694 Yankton, South Dakota 57075
DISTRICT ADDRESS
LU r
of
SEXTON'S EDORSE ENT: THE BODY ACCOMPANYING THIS PERMIT WAS RECEIVED AND WAS
i
INTERRED/CREMATED ON reh, 13. 19 _96, IN lair CEMETERY
OR CREMATORY LOCATED AT BlairTa (SIGNED) ""
SEXTON
GRAVE OR VAULT; BLOCK --H LOT GRAVE
HAS -0267 REV. 8/74 Rte,