Marie E CleaverLN
AME OF DECEASED Marie E. Cleaver
DATE OF DEATH October 2, 2009 I DEATH COMMUNICABLE MI
PLACE OF DEATH
CITY OR TOWN Missouri ValleFWNSHIP (IF KNOWN) COUNTY Harrison
BURIAL F_Xj I REMOVAL
CEMETERY CREMATORY
Blair
FULL NAME
CREMATION � I OTHER:
PLACE OF DISPOSITION
PERMIT
ISSUED
TO: ADDRESS
310 E. Huron St.
SIGNATURE
CITY OR VILLAGE
Blair
COUNTY
Washington
HENNE$SEY-AMAN
310 E. Huron
ISSOURI VALLEY, IA 51555
CITY
Missouri Valley
— EEI
STATE Iowa
El
STATE
Nebraska
STATE
Iowa
A CERTIFICATE OF DEATH MUST BE FILED IN ACCORDANCE WITH IOWA CODE CHAPTER 144. PERMISSISON
IS HEREBY GIVEN TO DISPOSE OF THIS BODY.
PERMIT SIGNATURE TITLE
ISSUED ADDRESS 310 E. Huron St.
BY:
CITY Missouri Valley STATE Iowa
DATE ISSUED ___October 5, 2009
NOTE: A BURIAL TRANSIT PERMIT IS NOT ISSUED FOR EVERY DEATH, ONLY UNDER THE PROVISION OF 10
CODE CHAPTER 144 SECTION 144.32. V1
1i 'HIM2=90".1
If a person other than a funeral director assumes custody of a dead body or fetus, the person shall securi
a burial - transit permit. To be valid, the burial -transit permit must be issued by the county medical examiner,
a funeral director, or the county registrar of the county where the certificate of death or fetal death was
filed. The permit shall be obtained prior to the removal of the dead body or fetus from the place of death
and the permit shall accompany the dead body or fetus to the place of final disposition. To transfer a
dead body or fetus outside •of this state, the funeral director who first assumes custody of the dead body
or fetus shall obtain a burial -transit permit prior to the tr,'ansfer. The permit shall accompany the dead body
or fetus to the place of final disposition. A dead body or fetus brought into this state for final disposition
shall be accompanied by a burial -transit permit under the law of the state in which the death occured.
588-0002 Rev. 10/93
CPL -09750