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Clyde A BrommerSTATE OF SOUTH DAKOTA DEPARTMENT OF HEALTH PERMIT NO. PERMIT FOR DISPOSITIONHUMAN ®Y .DECEASED -NAME FIRST -.MIDDLE LAST SEXDATE OF DEATtf(MONTH, DAY, YEAR) AGE (YRS) PLACE OF DEATH COUNTY CITY, TOWN OR TWP. U.S WAR VETERAN (YES%NO).... DISPOSITION AUTHORIZED: INTERMENT ,I TRANSIT DISINTERMENT p CREMATION SCIENTIFIC STUDY AND REINTERMENT Q PLACE OF DISPOSITION (NAME AND LOCATION OF CEMETERY, CREMATORY OR LABORATORY) r ' O PLACE OF DISINTERMENT (NAME AND LOCATION) O N 0 :O THISPERMIT.IS ISSUED:TO: , m 2 Ca` c',ronl ' c$WfFUNERAL DIRECTOR S.D. LICENSE NO.- -a. d :{�.�lai U �r2 ADDRESS:g�L���,t�_ at�LAI } g 30, g963, . REGISTRAR DATE. (IGNED) s REGISTRATION,- z 67621"1 ¢ DISTRICT �:��" gor Count ADDRESS Lac x2109 'B�ui ke, South .P ie` s