Hidgon, Joshua L # 1)
Kansas Department of Health and Environment
I_' Center of Health and Environmental Statistics
Office of Vital Statistics
1000 SW Jackson, Ste 120
Topeka, KS 66612-2221
Coroner's Permit to Cremate a Dead Body
Full name of decedent: JOSHUA L HIGDON
Decedent's address: 9640 N HIGHWAY 99 HWY, WAMEGO, KANSAS 66547
Date of death: 10/10/2021 Place of death: WAMEGO,POTTAWATOMIE COUNTY,KANSAS
Cause of death certified by: KELSIE 0 PITSENBARGER CNM
Permission is hereby requested to cremate the body of this decedent at: PINEVIEW CREMATORY
QUEENSBURY,NEW YORK,UNITED STATES
Permission requested by: JAMES R MEACHAM 2386
Funeral home's name and address: CAPITOL CITY MORTUARY, 3936 NW 16TH, TOPEKA KANSAS
Being sufficiently informed as to the causes and circumstances of the death of the above-named decedent,permission is
hereby granted to cremate the body as requested.
Coroner's signature:/E/KELSIE 0 PITSENBARGER Date: 10/13/2021
County of: POTTAWATOMIE
Instructions for Using and Completing the Coroner's Permit to Cremate a Dead Body
1. A dead body cannot be cremated without this permit. This pertains to any deceased being cremated in the State of
Kansas.
2. The funeral director is to obtain permission to cremate from a coroner. In cases of an out-of-state death,
permission may be obtained from a Kansas coroner if the body has been released to a Kansas funeral home or
crematory.
3. In the case of out-of-state disposition,this permit must be attached to the Out-of-State Transit Permit that
accompanies the body out of state.
4. In the case of out-of-state disposition,the Kansas license funeral director shall not issue an Out-of-State Transit
Permit when the body is to be cremated unless the funeral director has obtained the Coroner's Permit to Cremate
a Dead Body along with a complete and satisfactory Certificate of Death.
5. The Coroner's Permit to Cremate a Dead Body shall be retained by the crematory and is subject to examination at
any time by any coroner or representative of the Kansas Department of Health and Environment.
VS221 Rev.05/01/09
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#