Carroll R KnutsonCA ROM. R. KNUTSON Male I'June 4, 1984 'VAR VETERAN
AGE (YRS) 1'%'S1V"�;c'"e COUNTY CITY, TOWN OR I VVr- No (YES/NO)
01 IrArz n=,1+4me.%v%cs Fall Riaer Hot Springs I
DisAg'iriON AUTHORIZED: E] DISINTERMENT
)(K INTERMENT nTRANSIT AND REINTERMENT
0
[:] CREMATION F-1 SCIENTIFIC STUDY
4
PLACE OF DISPOSITION (NAME AND LOCATION OF CEMETERY, CREMATORY OR LABORATORY)
Blair Cemetery, Blair, Nebraska
O
PLACE OF DISINTERMENT (NAME AIMLJ LUC--Pv)
0
�
THIS RMIT IS ISSUED TO: '
986
Z
tkColley FUNERAL DIRECTOR S.D. LICENSE NO.
0
401 North Garden, Hot Springs, South Dakota
ADDRESS:
June 6 1984 (SIGNED)
,
REGISTRAR
DATE:
REGISTRATIOND
Fall River ADDRESS 906 North River, Hot Springs, Sout
akotah
DISTRICT
LU
SEXTON'S ENDORSEMENT: THE BODY ACCOMPANYING THIS PERMIT WAS RECEIVED AND WAS
j Z'
INTERRED/CRE M��LED ON L4�� fZ 19,kL4 IN 44 A
CEMETERY
(SIGNED)
OR CREMATORY LOCATED AT Z�'�
GRAVE OR VAULT; BLOCK LOT GRAVE
HAS -0267 REV. 8/714 CEMETERY RECORD