Herbert Jones JrFOREST LAWN CREMATORY
P. O. Box 12006, Florence Station
Omaha, Nebraska
Permit for Cremation
Complete the Following
REMAINS MIDST BE IN SOME FORM OF A CONTAINER
Cremation No. 7451
The undersigned authorizes FOREST LAWN CREMATORY to cremate the remains of
1/ �-_ r ke F- � J') o {' E j i�' and further authorizes that the
following disposition of the cremains be made:
Ship to Q �
yyl d l
❑ Interment or inurement dt Forest Lawn Cemetery
(Description of Property)
❑ Hold for further instructions. (If held longer than 10 days, a storage fee will be charged)
❑ Release to
I hereby certify that I am related to the deceased as CA i t t E
and that I have the right to authorize this cremation and determine the disposition of the
cremated remains: that any personal possessions have either been removed or may be de-
stroyed: and that the body contains no Heart Pacemaker. I further agree that I will indemnify
and hold harmless the crematory from any claims to the contrary including all liability and
claims related to the shipment of the�remated remains.
Witness [1"y
Signature of Funeral Director in Charge
67073
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Number
Nae of Deceased /, Y Q Yj
m
J o
Yt Q S aJ_y
Date of Birth :S'+yt 9
Age y
Home Address 16 �
Place of Death
Single, Married or Widowed 6k Y r
f d
Race% t
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Cause of Death CA Y"'o el'
Date of Death . 19
Z ?
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Date of Cremation ��Y �f%
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Nearest Relative Thr in A`eS
[ 1 t 1 e
REMAINS MIDST BE IN SOME FORM OF A CONTAINER
Cremation No. 7451
The undersigned authorizes FOREST LAWN CREMATORY to cremate the remains of
1/ �-_ r ke F- � J') o {' E j i�' and further authorizes that the
following disposition of the cremains be made:
Ship to Q �
yyl d l
❑ Interment or inurement dt Forest Lawn Cemetery
(Description of Property)
❑ Hold for further instructions. (If held longer than 10 days, a storage fee will be charged)
❑ Release to
I hereby certify that I am related to the deceased as CA i t t E
and that I have the right to authorize this cremation and determine the disposition of the
cremated remains: that any personal possessions have either been removed or may be de-
stroyed: and that the body contains no Heart Pacemaker. I further agree that I will indemnify
and hold harmless the crematory from any claims to the contrary including all liability and
claims related to the shipment of the�remated remains.
Witness [1"y
Signature of Funeral Director in Charge