Stone, Waltraud STATE OF UTAH DEPARTMENT OF HEALTH 7_
OFFICE OF VITAL RECORDS AND STATISTICS 2014007521
CREMATION / BURIAL-TRANSIT PERMIT STATE FILE NUMBER
THIS PERMIT MUST ACCOMPANY REMAINS TO DESTINATION
REQUIREMENTS FOR CREMATION/BURIAL-TRANSIT PERMITS:
Registrar: This permit may only be issued upon registration of a death certificate and review by the Medical Examiner's
Office when required.
Funeral Director or Mortuary: A Cremation/Burial-Transit Permit is required for dead bodies to be cremated, dead bodies or
fetuses to be transported out of Utah for final disposition, or when disposition is made by someone other than a licensed funeral
director. All cremations must be done by a licensed facility. All permits must be endorsed and recorded.
Dispositioner: A Cremation/Burial-Transit Permit is required for the removal and transport of dead bodies or fetuses from the
place of death and for final disposition.
Sexton: A Sexton or person in charge of any premises where interments are made may not inter or permit the interment of any
dead body or dead fetus unless the interment is made by a licensed funeral director or by a person holding a
Cremation/Burial-Transit Permit.
INFORMATION AS REPORTED ON THE ORIGINAL DEATH CERTIFICATE
1.DECEDENT'S NAME(First,Middle,Last) 2.SEX 3.DATE OF DEATH 3a.COUNTY OF DEATH
Waltraud Stone Female June 9,2014 Davis
4.DATE OF BIRTH(Month,Day,Year) 5.AGE 6.BIRTHPLACE
February 15, 1939 75 Germany
AUTHORIZATION FROM FAMILY OR INFORMANT
7.NAME OF NEXT OF KIN OR OTHER PERSON AUTHORIZING DISPOSITION(First,Middle,Last) 7a.RELATIONSHIP
Henry Stone Husband
8.MAILING ADDRESS(City,County,State)
3048 Stones way, Fort Ann, New York, 12827, USA
MANNER AND PLACE OF DISPOSAL(FUNERAL DIRECTOR)
10.NAME OF FUNERAL HOME/DISPOSITIONER 11.ADDRESS OF FUNERAL HOME OR DISPOSITIONER(City,County,State)
Serenity Funeral Home 12278 South Lone Peak Parkway Suite#103 , Draper, Utah 84020
12.NAME OF FUNERAL DIRECTOR/DISPOSITIONER(First,Middle,Last) 12a.LICENSE NUMBER
Larry L Hansen 8364548-0902
13.METHOD OF DISPOSITION(S)
(check Applicable Items): ❑ Burial in Utah ❑x Cremation ❑ Transit to outside of Utah ❑Other(Specify)
14.BURIAL DATE IN UTAH OR DATE BODY MOVED OUTSIDE OF UTAH 15.NAME OF CEMETERY,CREMATORY OR PERSON(S)RECEIVING REMAINS
(Month,Day,Year) 06/13/2014 Pine View Crematorium
16.ADDRESS OF CEMETERY OR CREMATORY(City,State)
Queensbury, NY
17.ADDRESS OR OTHER DESCRIPTION SUFFICIENT TO IDENTIFY SCATTERING OF REMAINS
A CERTIFICATE OF DEATH HAS BEEN FILED AS REQUIRED BY THE LAWS OF THE STATE OF UTAH.PERMISSION IS HEREBY
GIVEN TO DISPOSE OF THIS BODY. FOR QUESTIONS REGARDING THIS PERMIT,PLEASE CALL(801)538-6371 OR(801)538-6364.
n This death HAS been reviewed by the Office of the Medical Examiner. Remains ARE authorized for cremation and/or removal from
the state:
❑This death HAS NOT been reviewed by the Office of the Medical Examiner. Remains ARE NOT authorized for cremation and/or
removal from the state.
UDOH-OVRS-14 Rev.05/09