Thatcher, Payton Ohio Department of Health
Vital Statistics Removal from-State Permit
Permit no. 1201438
Name of Deceased Date of Death
PAYTON SHIRLEEN THATCHER June 10, 2017
Personal data Sex Age Place of death(Village or City) County
on deceased Female 7 Years CLEVELAND CUYAHOGA
Cause of Death
PENDING
Manner and ❑Burial IN Other(Specify) Removal from State
place of
Name of Cemetery 4/z7/2
disposal PINE VIEW CREMATORIUM r.)4i..1I ✓+ G/tirrede✓
A satisfactory Certificate of Death or Provisional Certificate of Death has been filed as required by t of this state.Permission to dispose of the body
as indicated above is hereby given to:
Authorization Funeral Director Address
to dispose of LAUMER, ALAN A 1601 MERWIN AVE
body CLEVELAND, OH 44113
Registrar/Sub-Registrar
1riondistrictno. 51e
GLSON, THOMAS P 80O June5, 2017
IREA2721
Rev.01/07 This permit must be retained by superintendent or person in charge of cemetery for a period of five(5)years