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Mills, Evangeline
State of New Jersey CASE ID NUMBER BURIAL, CREMATION, OR T�tANST PERMIT �� State law requires that no person shall cremate a dead human body unless 1502467 at least 24 hours have elapsed from the time of death listed on death record. City, Borough or Township Date of Issuance Westwood Borough, Bergen County 03/25/2012 The Certificate of Death having been filed with above,as required by the laws of this State, permission is hereby given for the transportation, removal, burial,cremation,or ether final disposition of the body of: Y Name of Deceased �a Age Sex Evangeline L Mills , ` 1 ears Female Place of Death °` 1 0 .' Date gf Death Time of Death Westwood Borough -- tgent--County ,.j � 12 6:50 AM Cause of Death ff cardiopulmonaryarrest Proposed Place of positr � , Method of Disposition Pine View ri m ant E- _ #,: Remo 1:17 State Queensbu rework ; Transportati Common(ate Yes me of Carver i-',0°02T:r.' °":„. 1,-'-c-, ,i1.,a',0' ;0.!' , 0,t.,0. 0,00 ',:f1-0:00.:\ \11 Name ands re s °Funeral Home, 1. 0) ), BeckerFuneralHome ,.. 6 ; _ 1 � 3 %Westy d,New Jersey / 75�03 Thispermit-rbust be delivered to thesupe 1.rintendent c _cemeteryor crematorium where burial,- ent b or cremation is t©take ce, who should fillthe` paces below and forward it w it in to ys t he Registraro Vital' to sties o d ict in icF the c0.0„emetery or crre na o um Whenur al fakes place to a c� retery hichxh noperson in chiarge,the spaces berm o e filled �y T rneral dir,. uld write` son inrg €. rt line fora r= of Superintendent Cemetery or Crematorium and file tbs.permith the`Registrari Statists f strict in wh ch t cemetery i o ited• T 0 lam requires that th,. ne within to s after burial — k- - G , -._, Name o De sew . x a (Date of Burial or Entombment _- ill‘ P (EI t 7 oil_ at , � ❑ LYJ P � AM M (Date and Time of Cremation) �L l (Signature o Supe ntendent of emetery or Crematorium) PENALTY FOR DISPOSAL WITHOUT PERMIT -$50 TO $100 REG-21X This Burial, Cremation or Transit Permit is electronically produced by NJ-EDRS Burial Permit ID MAY 07 and can be verified through the EDRS website at http://edrs.nj.gov 9700130