Sawn, Daniel c dIIP ' Oy
STATE OF ARIZONA
DEPARTMENT OF HEALTH SERVICES-OFFICE OF VITAL RECORDS Permit Number:
2016C0-004264
DISPOSITION TRANSIT PERMIT
NAME OF DECEASE.: SEX: DATE OF BIRTH:
DANIEL LEE SAWN Male 7/31/1961
DATE OF DEATH: PLACE OP DEATH(CITY OR TOWN): COUNTY: STATE:
1/23/2016 Flagstaff Coconino Arizona
CAUSE OF DEATH k
IDENTIFICATION CARDIORESPIRATORY ARREST
OF DECEASED
CAUSE OF DEATH B:
ACUTE INFERIOR MYOCARDIAL INFARCTION
CAUSE OF DEATH C:
CORONARY ARTERY DISEASE
✓.. D:
NAME AND Al)- UNERAL FACILITY:
WESTCO. ERAL HOME 1013 E MINGUS AVECottonwood,AZ
NAME OF FUNE SIGNATURE OF FUNERAL DIRECTOR: DATE SIGNED:
MANNER AND Todd Sturde,. 01/26/2016
PLACE OF DISPOSITION METRO,
DISPOSITION Removal/Creme
NAME AND LOCATION OF T!ISPO 1)ON FAIL
PINE VIEW CREMATORY Queensbury,NY
NAME AND LOCATION OF DISPOSITION FACILITY:
IN ACCORDANCE WITH ARIZONA STATE LAW AND THE REGULATIONS OF THE ARIZONA DEPARTMENT OF HEALTH SERVICES PERTAINING TO DEATH CERTIFICATES AND THE
HANDLING OF DEAD HUMAN REMAINS,AUTHORIZATION IS HEREBY GIVEN TO DISPOSE OF THIS BODY W THE MANNER INDICATED.
AUTHORIZING REGISTRAR: - -..J�_. T)ATE OF-AUTHORIZATION:
AUTHORIZATION FOR DISPOSITION Yasmine Sealy 01/26/2016
MEDICAL EXAMINER'S AUTHORIZATION: AUTHORIZED FOR CREMATION: DATE OF AUTHORIZATION:
Yasmine Sealy Yes 01/26/2016
I CERTIFY THAT THE ABOVE DESCRIBED REMAINS WERE DISPOSED OF AT THE FOLLOWING LOCATION AND BY DATE OF DISPOSITION:
THE METHOD SPECIFIED ABOVE. 01/26/2016
NAME AND ADDRESS OF DISPOSITION FACILITY:
PINE VIEW CREMATORY Queensbury,NY
DISPOSITION OF NAME OF PERSON IN CHARGE OF DISPOSmON FACILITY(PLEASE PRINT): SIGNATURE:
REMAINS Cli o f
NAME AND ADDRESS OF DISPOSITION FA IL CITY:4 N t'��"� .G
NAME OF PER IN CHARGE OF DISPOSITION FA LI TY( a PRINT): SIGNATURE:
L NRs30A4U, CfriWtr (�L
AAC R9-19-314 REQUIRES THAT A PERSON IN CHARGE OF A PLACE OF FINAL DISPOSITION IN ARIZONA SHALL MAINTAIN A COPY OF THIS
DISPOSITION TRANSIT PERMIT FOR FIVE YEARS FOLLOWING THE ISSUE DATE OF DISPOSITION.