Verification Of Reinterment {25.4}

PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE DISINTERMENT OF _______________________________________, DECEASED CASE NO. _________________________ VERIFICATION OF REINTERMENT The undersigned ____________________________________________________________ (Name and Title) of the _____________________________________ Cemetery, states that the remains of the above-named Decedent were reinterred on the ____ day of ____________________, 20 ___, pursuant to the Order of this Court. Signature Typed or Printed Name Cemetery Address Phone Number (include area code) Reset Form Print Form FORM 25.4 ­ VERIFICATION OF REINTERMENT Effective Date: March 1, 2014 American LegalNet, Inc. www.FormsWorkFlow.com