Smith, Lois Elaine .,. - TE Oj •. . BEXAR COUNTY MEDICAL EXAMINER'S Or i ICE
., ,'7`��° 7337 LOUIS PASTEUR s ,
" '_ SAN ANTONIO,TEXAS 78229-4565
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E' 'tir �\ ,�, (210)335-40000 ( LF
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`•.� �. FAX(210)335 4002
"Accredited by the National Association of Medical Examiners"
CREM N C :RT1 =e TE
•
Permission is granted to SAN FERNANDO III CREMATORY
located in SAN ANTONIO, "TEXAS
To cremate the body of
Lois Elaine Smith
Issued this 10th of December, 2015
e,,,,,,, ,f __
e
By:
Bexar County Medical Examiner
Waiting period has not been waived.
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SAN FERNANDO CREMATORY
OF THE CATHOLIC CEMETERIES OF SAN ANTONIO
CERTIFICATE OF CREMATION
BE IT KNOWN BY THESE PRESENTS:
That this is to certify that on this 15th day of DECEMBER ,20 15-
the remains of LOIS ELAINE SMITH
were cremated at San Fernando Crematory,San Antonio,Bexar County,Texas
under the direction of;-_ -- PORTER LORING MORTUARY
in accord with its rules and regulations and in compliance with the laws of the
State of Texas.
Cremation# 23482
.,''� Crematory Director
/ JENNIFER MCGEE
Notice:This temporary container is not intended for the permanent storage of cremated remains in
a niche,crypt,cremation interment container,or Interment space.
y
SAN FERNANDO CREMATORY
OF THE CATHOLIC CEMETERIES OF SAN ANTONIO
CERTIFICATE OF CREMATION
BE IT KNOWN BY THESE PRESENTS:
That this is to certify that on this 15th day of. DECEMBER ,20 15
the remains of LOIS ELAINE SMITH
were cremated at San Fernando Crematory,San Antonio,Bexar County,Texas
under the direction of, PORTER LORING MORTUARY ,
in accord with its rules and regulations and in compliance with the laws of the
State of Texas.
Cremation# 23482 ,'i'-r' '-`fit
-'' ,✓Crematory Director
JENNIFER MCGEE
Notice:This temporary container is not intended for the permanent storage of cremated
remains in a niche,crypt,cremation interment container,or interment space.
. :... -.. , ELM:1.X.MUU1 tf 7 ar13 1
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- BURIAL TRANSIT PERMIT
I Hamad DU:66W:Eh*/ ' WSW
AMI I
IS_ . EtAINE SMITH
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aim Dale CXDiath(nhuttldlyyy) WSW of DikpOsaltin
( In foe kl:FSMAIS 0 Burial 'ffli Ctenistion CI DShitlen 0 Ehttistimerit 0 Rerhovul In***
I 84 'Yrs DEOEMBER 0,2015 a mop modem.
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V: ARDEN PARK ASSISTED LIVING. ..SAN ANTONIO-111EXAft TEXAS
"•I -lianti d C'srssIery'--— Settemalcifilm
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10 SAN FERNANDO CREMATORY III SAN ANTONIO
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TEXAS
-1 Peint•Nerne of Funerit:OtriiCler or Minor'Actintss Such, *Wrist C4Y; State Zip Code.4w . . .. . . .
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1101.MCCULLOUGH —JENNIFER LUCIL.LE:MCG.-Ee : . .
11. AVFM IF - SAN ANTONIO TX 7821-Z.'
— -
-1-?FatRopti!----- County C.1~91 RI.NurribuF
P.2 REGISTRAR SAN ANTONIO CITY CLERK BEXAR
:i SAN ANTONIO 0213603
A certificate of death hairing been regliterad or completed in so far as possible;permission is hereby
II Oren for final disporiltion,transport,or removal of the body from the state of Texas,
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9*001 01g i Harris,Sta*Reiglatiet.tEittiectOnic Validation 1 :1-14/26•15,
"A Stroio#RfefIngOegl•ctforfP*1040rt nits,
RIOtstai Irk oifo. •---
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Vat Stotiloct iS Taxa Actioniitnitoirti Code Sac.l8i:20),V a dated bolsi-outwit tato be risnove.ctioni 1St wt...trah5POrttlil by catrationoartIer latItOrt
itlii.sattli,,or Crimiatert;thiltirieriirdirecitor:Cfrperkinacting as such shall,tibtalt1 a burial-Wrist OttatItitarg.thit itsAl tetOttat whore Ste*lath'ctellfictitq
is cavil;be pact oiltia1 the ttate.tetiltarat efeatitittTially through:9 Bantliu ofAttal Stittletta OW**death ittaltatitiOtt Oitterti.Th.0 tatOtts'shall*
Iay,44140-tratigt ktetittattAto certificate or itatti,tonitmivic irt seat as Otattibte hasbeett presented(owl 0 81.6 or thit title 000*to Lasktorntontr
•A file mother Mast be-assigned t/ .00,ieg15tt%S.S needed AcopyofthlS permitts to accOmparty the body in
bandit;ThereJanOleikEitith-0114d fOr the*vented a•Buriell-trartait Permit:.
Itan Incomplete death certificate IS used WA/Win thio'Budid Transit NOR,the-re010*will va1100te:thotthe body
is no longer nitOdOrl bYthegeftffietaCtIOS of death before issuing the permit to ensure,that a completed death
iliftiflOafe will be received "Completed in so far as Possible,"Means the Information relating to the deceased,
indlOdingitwrierne,date of death,place of:death evict funeral directer*InfOrMatiOn is*iireleted.In a few
Instances;the.CalSafil.,of death may not:00.0-000100,It*the reS00001hilki of the person presenting the
the C•eififidafitraf Death,and obtaining the Burial TrahSkOSifflit,tO:asstire that the fully completed Certificate of Death
IS MO Oe.:tOOte as.00.bto,
lrmccordancovithetata.stattite,IsefOre a-deed bodk.fari 00:6061004:0 crqMatksi Authorization must be signed and
blamed bylhornedlOalca*IninetoitlUetkle_Of the Pegol Of the county in which the death occurred shoWing.
that an autopsy was:performed or that hO autopsy was necessary:,If an inquest le betnO conducted by the
rriedital iselittior or justice of the peace authorization cremation from the medical examiner or justice of die
peace is required(fiSC il90O8.25TAC:§1812,il p.3]
*iiit..i.iioppEta_204
r`k Report of Death 000001813023
7 Vital Statistics 25 TAC Sec 181.2(a)"The funeral director,or person acting as such,who assumes custody of a dead body or fetus shall obtain an
,00 electronically filed report of death through a Bureau of Vital Statistics system or complete a report of death before transporting the body.The report of
death shall within 24 hours be mailed or otherwise transmitted to the local registrar of the district in which the death occurred or in which the body was
y found.A copy of the completed or electronic filed report of death as prescribed by the Bureau of Vital Statistics shall serve as authority to transport or
• bury the body or fetus within this state."
Print in dark ink the legal name of the deceased as shown on the Social Security card or birth certificate.
LOIS ELAINE SMITH LINDSAY
first middle last suffix AKA maiden
w
b
Date of Death 12 / 06 / 2015 Sex Female Date of Birth 02 / 27 / 1931
'o month day year month day year
Social Security Number 1 9 6 _ 2 4 - 0 2 9 8 ❑None ❑Not Available
Place of Death (check one)
❑Hospital Inpatient ®Nursing home/Long term care facility
a
❑Hospital Emergency Room/Outpatient ❑Home of Deceased
❑Hospital Dead on Arrival ❑Other(Specify):
❑Hospice Facility
• Facility Name(If not institution,give street&number)
I. ARDEN PARK ASSISTED LIVING
o City,Town,or Precinct Number County
SAN ANTONIO BEXAR
c
0
▪ Local registration office for the area where this death occurred: REGISTRAR-SAN ANTONIO CITY CLERK
❑This death may be due to homicide, suicide or accident; or this death occurred without
• medical attendance. Check One
Ell
This death will be certified by: ®Physician ❑Medical Examiner ❑Justice of the Peace
Name and address of certifier:
ANTONIO RUIZ
o 4440 PIEDRAS DRIVE S#125
G SAN ANTONIO,TX 78228
Name and address of person making this report(if funeral director list license number and funeral home):
• JENNIFER LUCILLE MCGEE 111965
• PORTER LORING MORTUARY MCCULLOUGH
1101 MCCULLOUGH AVENUE
SAN ANTONIO,TX 78212
C9 JENNIFER LUCILLE MCGEE -BY ELECTRONIC SIGNATURE 12/14/2015
Signature or electronic verification of person making this report Date of report
rt The Report of Death may be mailed, faxed, emailed, electronically registered or conveyed in
▪ person. A copy of this document is to accompany the body. This report contains confidential
• information.
Date/Time Received
Report
Certificate
Electronic
Registrar Use Only
VS-I 15 Revised 9/2004(may be duplicated)
Form No. 01
Record of Interments
1 Charles A. Smith /o -j=-4 0 5
1•.ipi5 Si.:}H Q-a6 'St%- is-i.o.a
2 Hannah M. Smith 7/o . P'° 6 1-4r cn:-}t{ q-a 3•aa aJp:' 1• 0°
s
Alice I. Smith 7 / 20/83 7 Virginia Josephine Winter (01-26-2009)
4 $
Harold J. Winter 8/23/03 (CRFM)
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SMITH Lot No. 373
Address 13 smith St., Glens Falls, N.Y. Section No. �7
Owner Charles A. Smith Plot Wah-Ta-Wah
Date Apr. 7, 1928
540 Superficial ft. @ 601 = $324.00
Location South side of Cheptonuc Ave. , Bd. east & west by Grass Paths; south
by Lynch & Whittemore .
Corner Posts
Remarks Mt.-2 markers were w►urre& 79g.. �s'73 a - � �Co Gyri iL/ �/'
)'Vi,c.�c
<1GZ of Q'tier r
Deed No. (and changes) 37 3
Payment Record (Paid 4./12/28
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\.AS Eck C`r
SMITH
NAME Lois Elaine Smith ge: 84
Lot Owner: Charles Smith
Lot# Wah-Ta-Wah sec.27 Lot 373 Grave# 1
Case: Urn a,
Died: 1 2.6.2 01 5 Interred:9.2 3 .2 2
Funeral Home: Porter Loring Mortuary
Cemetery: Pine View