LaFreniere, Michael •
7
AUTHORITY FOR FINAL DISPOSITION
y COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
C;oloa to Deppau ttmcnt
of Public
and faviranment
• It is unlawful for any person in charge of a burial place or crematory to permit burial or other disposition of a dead human body or fetus until a
final disposition permit has been issued.
• A final disposition permit may be issued only upon registration of a completed death certificate.
• 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 C.R.S. 12-54-307(2)(a)(IX).
• This permit does not supercede other legal requirements for burial and/or cremation on private property(meaning not an established cemetery or
crematory),such as city/county ordinance,land use regulations,convenants,etc.The landowner and/or
funeral director is responsible for determining if such requirements or restrictions exist,prior to final disposition.
This final disposition permit,when completed and bearing the required signature,constitutes authority for burial, interment,cremation,
removal from the state,or other authorized disposition of the deceased named below, in accordance with Section 25-2-111 C.R.S. 1982.
This permit must accompany the remains to their destination.
Name Of Decedent MICHAEL ANDREW GILLS LAFRENIERE Date of Death 09/02/2017
Sex MALE Age 33 YEARS Date of Birth 12/31/1983 Place Of Death AURORA ARAPAHOE
City County
Name of Funeral Establishment ASPEN MORTUARY
Address of Funeral Establishment 1350 SIMMS STREET LAKEWOOD COLORADO 80401
Type of Disposition REMOVAL FROM STATE
Place/Cemetery/Crematory PINEVIEW CREMATORY
City QUEENSBURY State NEW YORK
Additional information regarding transport and/or disposition(if needed):
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 to section 25-2-103 C.R.S. 1982 in the county where death occurred.)
State Registrar
Signature Title
4300 Cherry Creek Drive South, Denver, CO 80246 09/07/2017
Address Date
REV:OCTOBER 2015