Couture, Tiarra Ohio Department of Health }
Vital Statistics Removal from State Permit'
Permit no. 1201437
Name of Deceased Date of Death
TIARRA LYNN COUTURE June 10, 2017
Personal data Sex Age Place of death(Village or City) County
on deceased Female 13 Years CLEVELAND CUYAHOGA
PECause of DeI NGath
ND
Manner and 0 Burial M Other(Specify) Removal from State
place of Name of Cemetery � /
disposal PINE VIEW CREMATORIUM .�v./fd:rl ��.. 4 Gre-,4 ./v/. 6/ill
A satisfactory Certificate of Death or Provisional Certificate of Death has been filed as required by the ws of this state.Permission to dispose of the body
as indicated above is hereby given to:
Authorization Funeral Director Address
AVE
to dispose of LAUMER, ALAN A
body CLEVELAND, OH 44113
Registrar/Sub-Registrar
rationdietrictno. S GLSON, THOMAS P 1800 June15, 2017
HEA 2721
Rev.01/07 This permit must be retained by superintendent or person in charge of cemetery for a period of five(5)years
Town of Queensbury
AIWA
irlCertification of Cremation
lb,1 Pine View Cemetery and Crematory
This certifies that the remains of: Tiarra Lynn Couture
were cremated on June , 21 20 17 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death June , 10 20 17 Age 13
(Month) (Day)
Funeral Home Carleton Registered No. 476
,r,i 41. /.,..%---4---
(Au orized Signature)