Harold C PieperSTATE OF SOUTH DAKOTA
DEPARTMENT OF HEALTH
PERMIT FOR DISPOSITION OF DEAD HUMAN BODY
DECEASED -NAME FIRST MIDDLE LAST SEX
J4 DATE OF
Harold C. 1. ale Jul%
AGE (YRS) PLACE OF DEATH COUNTY CITY, TOWN OR TWP.
REGISTRATION th D&wta 57350
DISTRICT Bwle ADDRESS Huron
INTER RED/CREMATED ON 19 _L:�, IN CEMETERY
OR CREMATORY LOCATED AT (SIGNED) SEXTON
GRAVE OR VAULT; BLOCK -LOT RAVE
HAS -0267 REV. 8/74 CEME ERV RIE,CORD