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: L : | E : FUNERAL DIRECTORS FOUNDED 1050 May 4, 1972 Bir, Jobe », Mune snl Bureau of lavostigation agtou, Ds C. 20535 Services for TIM HONORALLE J, EDGAR HOOVER May 4, 1972 Profesofounl Services and Factlitios $ 695.00 Casket 9802.00 ‘Total Servicon and Crokot 8897.00 Wilbert 857 Vault 973,00 Dohelt: agen 173,09 To move und replace coping 78.00% Lwoustucnt 4 for family 160.00 Overthine o2 4 cers 20.00% 1 for clergy 65.00% * 2 for howorery bowers 99.00 1 for Bios Gavdy 45.00" Dz C, Biles Tax $ 469,00 344.00 $ 6125.00 A SAVING of $224.00 may bo if pots Ly Jous 6, 1042, Hebd O1 Punic Hoa 90 OF DENCH 72 | 03405 Gainciny Yes On i ror pine wali ‘unt Car Conn. Avess Ni, Wash Iain ocnis cat (CW OPERATION MEDICAL CERTIFICATION ae YA juke able i I a) Cenvtary ov. hae Chegisen ™ DOM vice ce, 2 Gy he ‘Date Issued: JULY 11, 1972 ED SEAL THIS IS TO CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT REPRODUCTION OF THE ORIGINAL CERTIFICATE FILED IN ORDER WITH THE VITAL RECORDS ( Co CLARA FOR UCAID COMPENSATION OP DECEASED CIVILIAN EMPLOYEE (RO DESIGR/IFL BENEFICIARY OR SUKVIVING SPOUSE) LAG, the undersigned, huvchy make elaia as... Pxeouter, sini for amounts due from the United States o» thy District of Columbis in the ease of .. John Edgar. Hoover who died P08 day of MAY, a 1972 2. At the time of death the decedent was a legal resident of The District of Columbia... , and was cmployed by the United States or the District of Columbia as follows: Federal Pureau of Thy tigation 8. The deceased is survived hy the following: Widow or widower (if none, so state) Name none Children (Show cach living child of the deceased. If none, 50 state) : Nuoae of Child Age ‘Street Address, City, State, and ZIP Code none Grandchildren (List only the children of deceased children. Name, Age, Street Address, City, State, and ZU? I none, s0 state) Name of Deceased Parent none (WU gates e189 oeaecued Uy ov on Bball eben ws Prardc 4. If no widow or widower, child or grandchild survives, enter below the name and address of each curvivin: parent, and state whether natural, step, foster or adoptive parents. (If none, so state.) Name of Porent Sivect Address, City, State, anil ZIP Code Mother . none eae ee Father. .ROne . - a PUP de voe are the soaiion pent ef te dere nicer paragranbe 7 ce at ae re tear gee eee eee i