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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
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(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