Crannell, Robert PERMIT FOR DISPOSITION OF HUMAN REMAINS
USE BLACK INK—MAKE NO ALTERATIONS OR ERASURES
NAME OF DECEDENT SEX DATE OF BIRTH DATE OF DEATH
ROBERT S. CRANNELL MALE JULY 28, 1916 DEC 30, 1986
PLACE OF DEATH-CITY OR TOWN PLACE OF DEATH-COUNTY (OR STATE IF NOT IN CALIFORNIA) NAME AND ADDRESS OF SPOUSE OR OTHER INFORMANT
LAGUNA BEACH ORANGE GERALDINE HUNTLEY (SISTER)
NAME AND ADDRESS OF FUNERAL DIRECTOR (OR PERSON ACTING AS SUCH) CALIFORNIA LICENSE NUMBER BOX 31 SUNNY S 1 D E NORTH
SIERRA M 'Ei ORI.AL CHAPEL MORTUARY '
P.O. BOX 8188 RIVERSIDE, CA 92515 ; 1139 GLENS FALLS, NY
TYPE OF PERMIT, CHECK ONLY ONE OF THE FOLLOWING TYPES OF DISPOSITION
X X 1. BURIAL(INCLUDES ENTOMBMENT) ❑ 5. DISINTERMENT AND BURIAL(INCLUDES ❑ 8. DISINTERMENT AND REINTERMENT OF CREMATED
ENTOMBMENT) REMAINS (INCLUDES INURNMENT)
❑ 2. CREMATION AND BURIAL(INCLUDES INURNMENT) ❑ 6. DISINTERMENT.CREMATION,AND BURIAL ❑ 9. DISINTERMENT OF CREMATED REMAINS AND
(INCLUDES INURNMENT) DISPOSITION OTHER THAN IN A CEMETERY
❑ 3. CREMATION AND DISPOSITION OTHER THAN IN A
CEMETERY 0 7 DISINTERMENT.CREMATION, AND DISPOSITION FOR CORONER'S USE ONLY
El 4. SCIENTIFIC USE OTHER THAN IN A CEMETERY
❑ 10. DISPOSITION PENDING
NAME AND ADDRESS OF CEMETERY WHERE REMAINS OR CREMATED REMAINS ARE TO BE INTERRED COUNTY
INTERMENT PINE VIEW CEMETERY CUEENS2URY, NY I WARREN
_ I
NAME AND ADDRESS OF CREMATORY WHERE REMAINS ARE TO BE CREMATED DATE CREMATED SIGNATURE OF PERSON IN CHARGE OF CREMATORY
CREMATION N/A
BURIAL AT SEA ADDRESS, NEAREST POINT ON SHORELINE. OR OTHER DESCRIPTION SUFFICIENT TO IDENTIFY FINAL PLACE AND COUNTY OF DISPOSITION
OR
DISPOSITION OTHER
THAN IN A CEMETERY N/A
OF CREMATED REMAINS
SCIENTIFIC NAME AND ADDRESS OF FACILITY RECEIVING REMAINS
USE N/A
This is to certify that I am the person having the right to control the disposition of the SIGNATURE OF APPLICANT
ACKNOWLEDGMENT remains of the above named decedent under provisions of the Health and Safety Code,
OF and I hereby acknowledge that trespass and nuisance laws apply and understand that DATE SIGNED
APPLICANT
this permit gives no right of unrestricted access to property not owned by me.
LOCAL THIS PERMIT IS ISSUED IN ACCORDANCE WITH PROVISIONS AMOUNT OF FEE PAID DATE PFFE?MIT I AJED SIGNATU E OC EGIS AR ISSUING RMIT
REGISTRAR OF THEO ITY FORNIATH DISPOSITION
ANDIOSAFETY CODE ANDISEMIS T �V 1 ri n
AUTHORITY FOR THE DISPOSITION SPECIFIED IN THIS PERMIT 5 (( '!V/ II
CERTIFICATION I CERTIFY THAT THE SPECIFIED y SIGNATU F PERSON IN CHARGE OF DISPOSI N LICE NU ER OF CREMATED REMAIN
OF PERSON IN CHARGE DISPOSITION WAS MADE ON '- 1 Z- / DISP SER,IF APPLICABLE
OF DISPOSITION (ENTER DATE) ► 4—Q • „ty
INDICATE ADDRESS OF REGISTRAR OF COUNTY OF DEATH l
IF DISPOSITION IS
TO OCCUR IN ORANGE COUNTY HEALTH CARE AGENCY P.O. ,BOX 355 SANTA ANA, CA 92702
ANOTHER COUNTY
COPY 1.OF THE PERMIT ACCOMPANIES THE REMAINS TO THE STATED PLACE OF DISPOSITION.THE PERSON IN CHARGE OF DISPOSITION IS RESPONSIBLE FOR
COMPLETING THE PERMIT AND FORWARDING THE COMPLETED PERMIT WITHIN 10 DAYS OF DISPOSITION TO THE REGISTRAR OF THE DISTRICT IN WHICH DISPOSI-
TION OCCURRED OR THE DISTRICT NEAREST THE POINT WHERE THE CREMATED REMAINS WERE BURIED AT SEA. THE LOCAL REGISTRAR MAY DESTROY ANY
ORIGINAL OR DUPLICATE PERMIT AFTER ONE YEAR.
COPY 1 STATE OF CALIFORNIA-DEPARTMENT OF HEALTH SERVICES-OFFICE OF STATE REGISTRAR OF VITAL STATISTICS REV. 1-86) FORM VS-9