Raymond J. VanSkiverKansas Department of Health and Environment, Office of Vital Statistics
1000 SW Jackson, Suite 120, Topeka, Kansas 66612-2221
(785) 296-1426
Out -of -State Transit Permit
Full name of decedent: Raymond J. VanSkiver Age: 87 Sex: Male
Date of Death: 11 / 22 / 2010 Place of death: Wichita Sedgwick Kansas
city or township county state
Point of final destination: Blair Cemetery / Blair, Nebraska
cemetery, crematory, or other point of destination
Permit
A certificate of death having been filed as required by the laws of the State of Kansas,
permission is hereby given to: Michael R. Ast #1998 11/23/2010
Funeral director's name license number date issued
Wulf-Ast Mortuary 911 Biermann - Garden Plain, Kansas 67050
Name and address of firm
to remove the above identified body from the State of Kansas for final disposition*
Issued by: (Michael R As!) 911 Biermann - Garden Plain, Kansas 67050
Signature of funeral director
Embalmer's name: Rickey D. Yoder
License number: 3107
The above transit permit is required for the removal of any dead body from the State of Kansas for interment, storage, or cremation and is to accompany the
body to the point of final disposition. (This form is not to be used for disinterment.)
vs210-A rev 11-2001
*When the body is to be cremated, a Coroner's Permit to Cremate a Dead Body is required in addition to this permit.