Wear, Christopher Scott �CI MLO 15:16 Swlhamt Rncl 5+c 508,72C5 7 Raga '
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Office of the State Medical EZartllnlers
t Certificate for Cremation
3emre removing a body m a crematory, Me Funeral Orncror MUSTobrd, a completed cam/caea for
.remarlon M1om me Dalpe of MR Seem MemW fiamiran. D
Can aumbrr V
1. tmmede.c.mm Chnitophcr S. Wem I denim
JW I6, 202D
ft. once deean sa clMraan A ape
5 Avmue of the Arts Room 915 Providence, Rt 52
S. Guvedoeem
Pending
S. MmCrt(Ym or Not r. Plenum
Yea Petdcia Ogaa MD
a Finartl llonr
South Coast Forward Home
1555 Pleasant SC Fall River, MA 02723
IlrorebYCMMY dal/haw made meldrY rao the ceun mNmanrrr of daMh. Aflar such epeey, on my
opirlba tlIM rut NrNareasmmedon w/asdelMdrY co'mamlW men death m mwsamy. l+ertnWM 4
hereahri given ro cremate me eddy Drones dMa eedydme decedaM named avow.
Y
mwM wane Department of Ofl m a tlla slab Medml f:rallalm
AS owes Prbrbb�ee, RI RI M01QW
To be CompleYd by Cmin"
ten amen doMn
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the Crematory shall send the odglnal completed form to RIDOH's Canter for Intel Records
(3 Capitol Hill, Room 101, Providence, R102909) and shall retain a copy of this completed
torte for its records.
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