Quintanilla DeLos Reyes, Juan Fernando EDR: 000044445526948,1-0Fi ,
,'\`P,.:V BURIAL TRANSIT PERMIT
Name of Deceased-First Middle Last
•
JUAN FERNANDO QUINTANILLA DE LOS REYES
Aga Sex Date Of Death(mmdd-yyyy) .Me t od of Disposition
®Male ❑Female Burial in Cremation 13 Donation ❑Entombment Removal from stale
62 YEARS D Unknown JANUARY 9,2023 I3 Mausoleum 0 Other(speafy)
Place of Death City-County State r
3925 HORIZON PL FORT WORTH,TARRANT TX
Name of Cemetery or Crematorium City State
COMMUNITY MORTUARY FORT WORTH TX
Print-Name of Funeral Director or Person Acting as Such Address City Code
MONIQUE OROZCO 5210 MC CART AVE. FORT WORTH TX 76115
0
t' lobar County City/Prednct File Number
A REGISTRAR-TARRANT COUNTY CLERK TARRANT FORT WORTH
1 A certificate of death having been registered or completed in so far as possible;permission is hereby
given for final disposition,transport,or removal of the body from the state of Texas.
s JANUARY 11,2023
Signature of Registrar or Electraric Validation44- Dale(asm m7r)
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Vital Statistics 25 Texas Administrative Code Sec.1812(b).if a dead body or fetus is to be removed from this state.transported by common
carrier within this state,or cremated,the funeral director,or person acting as such,shall obtain a burial-transit permit from the local registrar
where the death certificate is or will be filed,or from the state registrar electronically through a Bureau of Vital Statistics electronic death
registration system.The registrar shall not issue a burial-transit permit until a certificate of death,completed in so far as possible,has been
presented(See§181.6 of this title(relating to Disinterment)).'
A.file number may be assigned by the registrar as needed. A copy of this permit is to accompany the body in
transit.There is no fee authorized for the issuance of a Burial-Transit Permit.
If an incomplete death certificate is used to obtain the Burial Transit Permit,the registrar will validate that the body
is no longer needed by the certifier of cause of death before issuing the permit,to ensure that a completed death
certificate will be received.'Completed in so far as possible°means the information relating to the deceased,
including the name,date of death,place of death and funeral director's information is completed.in a few .
instances,the cause of death may not be completed.It is the responsibility of the person presenting the
the Certificate of Death,and obtaining the Burial Transit Permit,to assure that the fully completed Certificate of Death
is filed as soon as possible.
In accordance with state sfatute,before a dead body can be cremated,a Cremation Authorization must be signed
and issued by the medical examiner or justice of the peace of the county in which the death occurred showing
. that an autopsy was performed or that no autopsy was necessary.If an inquest is being conducted by the
medical examiner or justice of the peace,authorization for cremation from the Medical examiner or justice of the
peace is required.
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[HSC§193.008,25 TAC§181.2,§181.3]
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VS-116T Revised 9/2004
CERTIFICATE OF CREMATION
THIS IS TO CERTIFY THESE ARE THE REMAINS OF
JUAN FERNANDO QUINTANILLA DE LOS REYES
WHO WAS CREMATED AT COMMUNITY MORTUARY SERVICES
OF FORT WORTH, TEXAS
ON JANUARY 13, 2023
CASE # 98-23 ID TAG # 24451
WHOSE CREMATION WAS ORDERED BY
AMALLA FUNERAL HOME
OF FORT WORTH, TEXAS
THE CREMATION WAS PREFORMED BY A CERTIFIED CREMATORY
OPERATOR IN ACCORDANCE WITH ALL TEXAS LAWS.
CREMATORY OPERATOR
SIGNATURE
Quintanilla DeLos Reyes LF
NAME 62
Juan F. Quintanilla DeLos Ttgyes
Lot Owner: Diandra Lee Queintanila-Toscano
Lot# Algonquin Sec F R9 ##86 Grave# 1
Case: Urn
Died: 6. 9.23 Interred: 4 . 1 4 .2 3
Funeral Home: Community Mortuary Forth Worth Tx
Cemetery: Pine View
Quintanilla-Toscano
L.CF
Owner
Diandre Lee Queintanila-Toscano
Address Plot
5 Wincrest Dr. Queensbury, NY 12804 Algonquin
Phone # Lot #
646-874-9493 Sec F Row 9 #86
Deed # Date
4370 2 . 13.23
Cost Foundation Y - N
$400.00
Location
North-Vacant
South-Vacant
West-Vacant
East-Road
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: DATE:O2/13/Z.7)
SIGNATURE: DATE:
Record of Interments ,c3L: u,9.
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Sinn u.in n�1la ekes
2 7
3 8
4 9
5 10
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