Wheatlake, Phyllis 11/20/2015 08:26 15187921287 REGAN & DENNY FUNERA PAGE 01/01
11/19/2015 2:44 PM FROM: Z162760845 TO; +15187821287 P,
11/19/2015 2:02 PM FAX 3039932345 MILE HIGH FFC a 0001/0001
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AUTHORITY FOR FINAL DISPOSITION
Cotorado Department of Public Health and Environment
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- it is unlawful for any person in charge of a burial place or crematory to permit burial or other
disposition of a dead hw1'man body or fetus until a final disposition permit has been issued.
- A final dispoSition permit may bC issued only upon reoistrntion of a completed death certificate.
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• A final disposition permit is required for any type of disposition of a dead human body or fetus.
- This permit may be used for transporting by common carrier.
• This permit meets all the requirements of L.R.S. 12-54-307(2)(a)(IX).
• 1'his permit does not supersede other legal requirrement' for burial and/or cremation on private
property (meaning not an established cemetery or crematory). such as city/county ordinance,
• bond use mutations, covenants, etc. The landowner and/or funeral director is responsible for
determininrg if such requirements or reStriCtions rxitt, prior to final disposition.
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This final disposition permit, when complt:4:d and heating the required signature, constitutes authority Ioi
burial, inter meet, cremation, removal from the state, or other authorized disposition of the deceased
• named below, in accordance with Section 25.2.111 C.R.S. 1952. This permit must accompany the remains
• to their destination.
Name of decedent Phyllis 0 WHE LAKE -- Date of Death November 13,201S
Sex Female Age 101 Date of Birth October 31, 1914 Place of Death Thornton Adams
Crty County
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Name of Funeral Establishment MILE HIGH FAMILY SERVICES
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Address of Puneral establishment 1220 S. JASON STREFT, otrive t, CO 60223
Type or disposition Removat from State Place Pine View Cemetery •
cemetery or Crematory
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Cicy Queensbury �_.. State NCw YorK
Apditlonat information regard1nn transport and/or disposition (if needled)
I have examined the completed death certificate for the decedent named above, and authorize final disposition of the
remains. (To be signed by the office designated or established pursuant t0 Section 25.7.•103 C. i.5. 1932 In the county
where the death occurred,)
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Signature Title
4201 E.72nd Avenue, Unit D, commerce City, CO 80022 _ November 17, 2015 •
Address Date
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