Lindsey, Sharon ii
PERMIT FOR DISPOSITION OF HUMAN REMAINS
NAME OF DECEDENT SEX DATE OF BIRTH DATE OF DEATH
Sharon Lee Lindsey Female 04-16-59 04-16-59
PLACE OF DEATH—CITY OR TOWN PLACE OF DEATH—COUNTY (OR STATE IF NOT IN CALIFORNIA) NAME AND ADDRESS OF SPOUSE OR OTHER INFORMANT
Santa Barbara Santa Barbara Bernard Lindsey
NAME OF FUNERAL DIRECTOR (OR PERSON ACTING AS SUCH) 1 CALIFORNIA LICENSE NUMBER 5514 Catellina Way
Welch-Ryce Assoc. ; 303 Santa Barbara, Ca.
TYPE OF PERMIT. CIRCLE ONLY ONE OF THE FOLLOWING TYPES OF DISPOSITION
f. BURIAL(INCLUDES ENTOMBMENT) 5. DISINTERMENT AND BURIAL (INCLUDES DISINTERMENT AND REINTERMENT OF CREMATED
ENTOMBMENT) REMAINS(INCLUDES INURNMENT)
2. CREMATION AND BURIAL (INCLUDES INURNMENT)
6. DISINTERMENT.CREMATION.AND BURIAL
3. CREMATION AND BURIAL AT SEA OR DISPOSITION (INCLUDES INURNMENT)
OTHER THAN IN A CEMETERY(AS PROVIDED FOR IN 9. DISINTERMENT OF CREMATED REMAINS AND BURIAL
HEALTH AND SAFETY CODE) 7. DISINTERMENT.CREMATION.AND BURIAL AT SEA AT SEA OR DISPOSITION OTHER THAN IN A
OR.DISPOSITION OTHER THAN IN A CEMETERY CEMETERY (AS PROVIDED FOR IN HEALTH AND
4. SCIENTIFIC USE (AS PROVIDED FOR IN HEALTH AND SAFETY CODE) SAFETY CODE)
FOR THE PURPOSE OF ISSUING THIS PERMIT. DISINTERMENT IS DEFINED AS THE REMOVAL OF HUMAN REMAINS FROM ONE SPECIFIED PLACE OF DISPOSITION TO ANOTHER SPECIFIED PLACE
OF DISPOSITION. COMPLETE EACH ITEM REQUIRED FOR THE TYPE OF PERMIT SPECIFIED ABOVE AND INVALIDATE EACH LINE NOT REQUIRED FOR THE SPECIFIED DISPOSITION.
NAME AND ADDRESS OF CEMETERY WHERE REMAINS ARE TO BE INTERRED ;COUNTY
BURIAL N/A
I
I
NAME AND ADDRESS OF CREMATORY WHERE REMAINS ARE TO BE CREMATED DATE CREMATED SIGNATURE OF PERSON IN CHARGE OF CREMATORY
CREMATION N/A
INTERMENT NAME AND ADDRESS OF CEMETERY WHERE REMAINS ARE TO BE INTERRED , 44,ta` U1TY
AFTER (/"
CREMATION , , New York 1�,,,, t/�,2 ,, +
BURIAL AT SEA ADDRESS. NEAREST POINT ON SHORELINE. OR OTHER DESCRIPTION SUFFICIENT TO IDENTIFY FINAL PLACE AND COUNTY OF DIS 7 OSMON
OR
DISPOSITION OTHER
THAN IN A CEMETERY N/A
OF CREMATED REMAINS
SIGNATURE OF APPLICANT
This is to certify that I am the person having the right to control the disposition of the
ACKNOWLEDGMENT remains of the above named decedent under provisions of the Health and Safety Code, ,
OF
APPLICANT and I hereby acknowledge that trespass and nuisance laws apply and understand that DATE SIGNED
this permit gives no right of unrestricted access to property not owned by me.
SCIENTIFIC NAME AND ADDRESS OF FACILITY RECEIVING REMAINS
USE N/A
LOCAL THIS PERMIT IS ISSUED IN ACCORDANCE WITH PROVISIONS OF AMOUNT OF FEE PAID DATE PERMIT ISSUED SIGNATURE OF LOCAL GISTR R ISSUING RMIT
REGISTRAR THE CALIFORNIA HEALTH AND SAFETY CODE AND IS THE $2.00 01-17-77 Ii 9 C 0 ���/
AUTHORITY FOR THE DISPOSITION SPECIFIED IN THIS PERMIT L �'i�/. /J i{jj
CERTIFICATION � � ' SIGNATURE OF PERSON IN CHARGE OF DISPOSITION
OF PERSON IN CHARGE I CERTIFY THAT THE SPECIFIED DISPOSITION WAS MADE ON �
OF DISPOSITION (ENTER DATE) /`� "��!
COPY 1 OF THE PERMIT ACCOMPANIES THE REMAINS TO THE STATED PLACE OF DISPOSITION. THE PERSON IN CHARGE OF DISPOSITION IS RESPONSI FOR COMPLETING THE PERMIT AND FORWARDING THE COM-
PLETED PERMIT WITHIN 10 DAYS TO THE LOCAL REGISTRAR OF THE DISTRICT IN WHICH DISPOSITION OCCURRED OR TO THE LOCAL REGISTRAR OF THE DISTRICT NEAREST THE POINT WHERE THE CREMATED RE-
MAINS WERE BURIED AT SEA.
COPY 1 STATE OF CALIFORNIA—DEPARTMENT OF HEALTH—OFFICE OF THE STATE REGISTRAR OF VITAL STATISTICS (REV. 4-1-75) FORM VS-9