Barbara I HillmanTRANSIT COPY STATE of AMZONA REGISTRAR®S
(THM COPY A^USWACCOMPANY DEPARTMENT OF HEALTH SERVICES — VITAL RECORDS SECTION - FILE Nth.
Om OI_L DF.STMATION _ BURIAL — TRANSIT PERW'
NAME 11 - -.f TA ,� FIRS
S MIDI C , LAST —' -' -`
CASED akaBarbara I o ""Hillman SE>, iiGE RA -
DEC OR CCiL4rR
IDENTIFICATION Barbara I Elmer z. Female �, 65 AWhite
DATE OF DEATH PLACE OF DEATH A. TOWN OR CITY - CSTATE
=77—
OF ,.October 23, 1975 ,,D®O®A®Saint Mary's Hospital, Tucson, Pima, Arizona
DECEASED CAUSE OF (MUST BE COMPLETED IF BODY IS SHIPPED OUT OF STATF, MOVED BY COMMERCIAL CARRIER, OR A DEATH FROM'ERT AIN D75 EASES}
DEATH
7, Natural Causes
-R
BURIAL FUNERAL NOME A. NAME B. ST. ,ADDRESS C, CITY AND STATE
MANNER OTHER
❑ CREMATION (SPECIFY) 9. Evergreen Mortuary, 3015 N. Oracle Road, Tucson, Arizona
AND FUNERAL DIRECTOR'S SIGNATU, ATE SIGNEDREMOVAL .-,GLACE DF cremains 1// �'�`�_JD
10-28-75
>'4
DISPOSITION PLACE OR BURIALTIO OR A. NAME' STREET ADDRESS C. CIT AND STATE
OTHER DISPOSITION
7,� jam-, � p (�
REGISTRAR'S 93. IN ACCORDANCE WITH THE LAWS OF THIS STATE AND THE REGULATIONS OF THE DEPARTMENT OF HEALTH SERVICES PE P.TP.INTNG TO DEATH CERTIFICATES
AND THE HANDLING OF DEAD HUMA REMAINS, AUTHORIZATION I ERE BY GIVEN TO DISPOSE OF THIS BODY IN THE MANNER INDICATED.
AUTHORIZATION REGIST R.4 S IG ATURE
FOR D REG. DISTRICT DATE SIGNE
DISPOSITION
➢5.
DISPOSITION BURIED OR C. CITY AND STATE /
'. BODV AS: E l RY F A. NAME B. STREET A �a
CREMAT❑
➢B,
OF BODY [ CREMATED DATE OF DISPOSITION CEI�4ETERY MANAGER'S SIGNATURE
II''--�� ISPECIFY)
17_iIOTHER
STATE -- ' - ""' c yr ricr= REGISTRAR'S SIGNATURE TITLE -
REGISTRAR USE 121, 122 A
zz B
VS -7 REV. 7-74 7,3 �1T,z) IM'IGR SJ:, R Z 3Nd ; DAYSTO VITAL .
..,, f�...�'.:r. ii_ BOX 3,987' DE.:'ARTMEiN a ,? 1E A.I_, E- S2,ARVCES, PHOFNIk, °rR,ZOj. .