Conkling, David C:ULUHAUU Utt'MK I IVItIV I Ut- H t A L I H
0 DISPOSITION - REMOVAL PERMIT NO._
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NAME OF n/ /J /�/y ' '7,.� / DATE OF / //>/!s`
- DECEDENT 'l ,d-'L�if /�'%4%""".-�l,s SEX �///i(� DEATH (i/ 7E7/
{� DATE OF //� /q ACE OF /(�' L clif-76,
OAGE /rp BIRTH C/ 014 /9,�2 DEATH dL GG$GL�1LR../ c/�L ; Q p //11 COUNTY ITY ATE
2 DEATH OF / �j� ' I `JJ, //L
DEATH ` i1.✓l.Pi f C%��� J u-e Z.-4'-,...4 44.1
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IN ACCORD WITH THE LAWS OF THIS STATE, PERMISSION IS HEREBY GIVEN TO THE FUNERAL DIRECTOR NAMED
X BELOW, DULY LICENSED BY THE S ATE OF COLORADO, TO DISPOSE OF THE BODY
�IDENNTTIFIEDABOVE.
CL / NAME F FUNE AL DIRECTO o AD6RESS
g TYPE OFNAME.
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U DISPOSITION AXi'f"/C-O�"t-� PLACE �!�'�' :'1"�` 1 G'
Q CEMETERY OR CREMATORY CITY ST
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REGISTRATION DISTRICT �i /j/' / ";777.
��I DATE / /4 / ��a/'I.- SIGNATLOCAL REGISTRAR
ITEMS BELOW TO BE COMPLETED BY CEMETERY OR CREMATORY OF ICIAL: loci y-
D- BODY WAS ON �j �9� IN LOT 0/7� al
� SECTION
- PLACE * r /.�" (J�+
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READ CAREFULLY
REGISTRAR: A DISPOSITION-REMOVAL PERMIT MAY BE ISSUED ONLY UPON RECEIPT OF A
DEATH CERTIFICATE--NOT BEFORE.
FUNERAL DIRECTOR: A DISPOSITION-REMOVAL PERMIT IS REQUIRED FOR ANY MANNER OF
DISPOSITION OF A DEAD HUMAN BODY OR FETUS, INCLUDING INTERMENT, REMOVAL, STORAGE,
CREMATION, AND TRANSPORTATION.
WHEN USED AS A REMOVAL PERMIT FOR TRANSPORTATION BY COMMON CARRIER, THIS PERMIT
OR A DUPLICATE THEREOF SHOULD BE ENCLOSED IN A STRONG ENVELOPE ATTACHED TO THE SHIPPING
CASE. No SEPARATE REMOVAL PERMIT IS REQUIRED.
BEFORE SHIPMENT BY COMMON CARRIER, THE BODY MUST BE ENCLOSED IN A TIGHTLY SEALED
CONTAINER.
SEXTON: IT IS UNLAWFUL FOR ANY PERSON IN CHARGE OF A BURIAL PLACE OR CREMATORY
TO PERMIT BURIAL OR OTHER DISPOSITION OF A DEAD HUMAN BODY BEFORE A DISPOSITION-
REMOVAL PERMIT IS DEPOSITED WITH HIM.
ALL PERMITS MUST BE ENDORSED, RECORDED IN YOUR SEXTON1S REGISTER, AND FORWARDED
WITHIN FIVE DAYS TO THE LOCAL REGISTRAR OF YOUR TOWN OR COUNTY.