Sulyk, Nina PERMIT FOR DISPOSITION OF HUMAN REMAINS
STATE OF CALIFORNIA—-DEPARTMENT OF PUBLIC HEALTH
I NAME OF DECEDENT DATE OF DEATH
NINA JANE SULYK January 6, 1962
DECEDENT SEX COLOR OR RACE BIRTHPLACE (STATE OR FOREIGN COUNTRY) DATE OF BIRTH
DATA Female Caucasian New York May 10, 1940
PLACE OF DEATH—CITY OR TOWN PLACE OF DEATH—COUNTY(OR STATE IF NOT IN CALIFORNIA)
Inglewood Los Angeles
CHECK ONE: NAME AND ADDRESS CF CEMETERY OR COLU N BARIUM WHERE REMAINS ARE TO BE INTERRED
DISPOSITION DISINTERMENT AND Pine View Cemetery,GlensFalls,New
BURIAL I ENTOMBMENT CREMATION REINTERMENT
FUNERAL NAME OF FUNERAL DIRECTOR(OR PERSON ACTING AS SEEN) NAME OF SPOUSE OR OTHER INFORMANT ADDRESS OF SPOUSE OR OTHER INFORMANT York
DIRECTOR AND 4245 Dontomaso Dr.
INFORMANT Pierce Brothers,Venice Richard Sluyk(Husband) Los Angeles 8, California
In accordance with provisions of the California Health and Safety Code permission is hereby granted for disposition as specified in this permit.
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REGISTRAR DATE PERMIT ISSUED SIGN R F 9OCAL REGISOAR /+Q F� 7
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CEMETERY OR DATE CREMATED OR INTERRED SIGNATURE OF PERSON IN CHARGE OF CEMET OR COLUMBARIUM (((J!!l "'
COLUMBARIUM ►
SEE INSTRUCTIONS ON REVERSE
REV. 1-I-S7. FORM V5.9
( USE OF PERMIT '` "`�',._�� _
PERMIT FOR BURIAL, ENTOMBMENT OR CREMATION: _
Upon presentation of a satisfactory and complete certificate of death, a permit is issued by the Local Registrar of the
district in which the death occurred or the body was found. The permit shall accompany the remains to the place of
burial, entombment or cremation specified in the permit. This permit is the only authority required for the transportation
of human remains. A permit issued in this State is valid and sufficient in any county it specifies as the place of interment,
subject to the payment of any interment fees required by local law. The person in charge of the cemetery or columbarium
shall complete and sign the permit in the spaces provided and forward the permit within 10 days to the Local Registrar
of the district in which the cemetery is located.
PERMIT FOR DISINTERMENT AND REINTERMENT:
The permit is issued in duplicate by the Local Registrar of the district where the remains are to be disinterred upon written
application as provided by law and the payment of the fee of $0.50. One copy of the permit shall be given to the person
in charge of the cemetery or columbarium where the remains are to be disinterred. The other copy of the permit shall
accompany the remains to the place of reinterment specified in the permit. This permit is the only authority required for
the transportation of human remains. A permit issued in this State is valid and sufficient in any county it specifies as the
place of reinterment, subject to the payment of any interment fees required by local law. The person in charge of the
cemetery or columbarium where the remains are reinterred shall complete and sign the permit in the spaces provided and
forward the permit within 10 days to the Local Registrar of the district in which the cemetery is located.
27227 9-60 300M Q SPO