Eva Catherine ChristiansenVITAL RECORDS SECTION
4
IOWA STATE DEPARTMENT OF HEALTH
BURIAL -TRANSIT PERMIT
Full Name ofDeceased__E_ va _ Catherine Christiansen _______________-____----
------------------------------------------
La.pcoln Lanca star- Nebraska
Place of Death-----------------------------------------------------------
(Fow--n-or C or City) (County) (Sta e
Date of Death_ December 17 79 va ite female 77 ears
-----------------------> 19---- Color------------ Sex------------ Age----------
Cause
-----Cause of Death- -hand-ing-------------------- - -----------------
----------------------------------
E�alr Cemetery
Method of Disposal---.i-urd c11----------------------------------------- -----------------------
----- -(Burial,-Cremation, Transportation, etc.) ---- ----- (Cemetery or Crematory)
Uda sr17_i1 tQ11 State__�Tehra ska ___--
Town__la1Y--------- County -----
Certificate of death having been filed as required by laws of this state, permission is hereby given to
Funeral Director:
Ike e _ �neral__HQme______ Address -5L _ti'��llow_Ave�__Co®_Bluf'fs._IA
Roper &, Sons T� Vtuary 6 St, Lincoln, `
to dispose of body of said deceased as above stated. -����
Signature---- (�=----------------
(Registra
December_ 2Q 1979_ Address -------- -------------
Date_____ - --- -
'--' (City own and County)
CREMATORY THORITY SAL FILL OUT SPACW
11EMETERY"OR
�L ,L ----------------
Body was_ - ---- on---- --- (Cemetery or Crematory)
her rematgd Buried
Y ----------
Located - - -----=------------------
at � ___ ---_ ;-- ----- Signatu __
t exton or Person in Charge)
SEE OTHER SID
This permit must be endorsed by the sexton (or by the Funeral Director where there is no sexton) and
returned to the registrar within 10 days. Form V. S. No. 9
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