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DISPOSITION OF REMAINS <br />NAME OF MORTICIAN PREPARING REMAINS <br />Kyle Cherrington <br />GRADE <br />GS -11 <br />LICENSE N : ; /FI T - E <br />116 : 002 Uta ei, <br />OTHER <br />INSTALLATION OR ADDRESS <br />USAMAA -E <br />CMR 402 Box 1717, APO AE 09180 <br />DATE <br />05SEPO6 <br />SI 'A <br />CO , <br />NAME OF CEMETERY OR CREMATORY <br />T " <br />LOCATION OF CEMETE - la CREMA • ' Y AP) N <br />nnCC i <br />� <br />TYPE OF DISPOSITION <br />❑ BURIAL ❑ CREMATION ❑ REMOVAL (Specify) <br />D T DISPOSRIdN 1 ` �C <br />`(' <br />S <br />REGISTRATION OF VITAL STATISTICS <br />7 , <br />V w HL MO <br />REGISTRY (Town and Country) <br />DATE REGISTERED <br />FILE NUMBER <br />STATE <br />OTHER <br />NAME OF FUNERAL DIRECTOR <br />ADDRESS <br />SIGNATURE OF AUTHORIZED INDIVIDUAL <br />DD FORM 2064, APR 1977 (BACK) <br />(REMOVE, REVERSE, AND RE- INSERT CARBONS BEFORE COMPLETING THIS SIDE) <br />I certify that this is a une pOS 01 o g ; <br />co py of a doormat <br />MITZULI FIELDS <br />SFC, USA <br />NCOIC, Pt Affairs Division <br />WITH GENERAL POWER'. <br />OF NOTARY PUBLIC <br />10 U.S.C. <br />Section 1044 a <br />201805 <br />USAPA V1.00 <br />