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HAUG, GEORGE
Roseland Road
P. O. Box 31
Roseland, Fl
J
DEED #404
Block 46 Lots 7 & 8 Unit 2 Addition
George interred lot 8, 11121180
Ste- lLO�Y
Paid by General Receipt No. ....182_ . ....... Dated4 /22/.80....................
list Price r. *20D .DO t t.... Maximum No. Burial spaces ...2....... .
Discount $ .................. Total area in square feet ................
Net Paid $..'�. *.2Q0..OQ *. *. Monument permitted ....Flat...........
R &R Attached (Data above this line for City Record only)
DEED #404
George J. Haug
Roseland Road
P. 0. Box 31
Roseland,, Fl
B1k 46 Lots 7 & 8 Unit 2
Georgia Department of Human Resources
Vital Records Service
PFRUIT F93R THE DISPOSITION OF HUB I REMAINS
A
PF MIT Nt)MRER
Name of Deceased
Date of Death
Fatel, Daath7
NO
1, CATHihINE REGAN KIRBY HAUG
2. 198LL
3, YES O
Piece of Death Hospital or Street No.1 OR Interment Cemetery
City, Town or Location of Death OR Interment County of Deso OR Interment
4. SMITH C01vL4JNI'rY HOSPIT
6. s.
Name of Certifying Physician Coroner or Medical Examiner
Csrtifler's Address (Not Used For Disinterment/Reinterme
(Not Used For Disinterment/keinterment)
7. W. TOJWJ GEIMO
B•
Funeral Home Name and Address
Funeral Home LIc. No.
s. IVWRTIN FUNERAL HOW P. O. BOX 426,
HAHIF(A BA 31.652
10.
Method Of Disposition.
OR
Dete of Disposition OR
ReIn rmant
a11.
Burial O Transport CS 8torapa ❑
Disinterment/
❑
12. NOV. NO 61 1984
Cremation 13 Donation O Other 13
Relnterment
Name and Address of Disposition OR Raintwmeot Site
Location of Disposition OR Flainterment Site
(County, City or Steal
13. SEBASTIAN CE1vZT&W
14.
A Certificate of Death having been filed or the requirements of the laws of Georgia having been complied with, permission is hereby
granted to (check only ONE DISPOSE OF IJ DISINTER /REINTER 0 this body. (Go. Code 88 -1717)
► 16. NU
15.
Sext Or rson In Charpe — Signature) Data SlprMd
17.
Form 3934 (Rev. 1.79) ) UNERAL DIRECTOR
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