Carl Marcus PetersenSTATE OF SOUTH DAKOTA
DEPARTMENT OF HEALTH PERMIT NO.
rimbf MIUULt LAST SEX DATE OF DEATH (MONTH, DAY, YEAR)
CARL MARCUS PETERSEN � male � January 9. 1989
(YES/NO)
85 GregoryBones-teel No
DT9FOOTION AUTHORIZED:
U INTERMENT Xp TRANSIT � DISINTERMENT
f-] CREMATION [:] SCIENTIFIC STUDY AND REINTERMENT
PLACE OF DISPOSITION (NAME AND LOCATION OF CEMETERY. CREMATORY OR LABORATORY)
Blair Cemetery Blair, Nebraska
-
PLACE OF DISINTERMENT (NAME AND LOCATION)
THIS PERMIT IS ISSUED TO:
Cameron Clausen — FUNERAL DIRECTOR S.D. LICENSE NO. 922
ADDRESS: P. 0. Box 210, Burke, South Dakota 57523
DATE: January 10. 1989 (SIGNE
REGISTRATION
DISTRICT Gregory County ADDRESS Burke, South Dakota 57523
SEXTON'S ENDORSEMENT: THE BODY ACCOMPANYING THIS PERMIT WAS RECEIVED AND WAS
INTER RED /r,)$XMMp ON January 12 19 _89— IN B 1,3 i r CEMETERY
ORMWAVOW LOCATED AT Blair, Nebraska (SIGNED,
5�7 SEXTON—
GRAVE OR VAULT; BLOCK LOT -33 GRAVE
HAS -0267 REV. 8/74
L,', R F L L 'Ofll H [-ere CA L R EGI'i'ST R"t A, R � 1%,COO U N 1 Y �JV hi E E B ii R 1 i L 0 C C URS
— TO E - � —,