Alma Louise VanSkiverM
4; Kansas Department of Health and Environment
Center of Health and Environmental Statistics
Office of Vital Statistics
1000 SW Jackson, Ste 120
Topeka, KS 66612-2221
Out -of -State Transit Permit
Full name of decedent: ALMA LOUISE VANSKIVER Age: 86 Sex: Female
Years
Date of Death: 09/23/2011 Place of Death: WICHITA, SEDGWICK County KANSAS
(city, county & state)
i
Point of final destination: BLAIR CEMETERY
(name of 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:
Funeral Director: JEANNIE VOLES 4844
(name and license number)
Date Issued: 09/30/2011
Funeral Home: BAKER FUNERAL HOME -VALLEY CENTER, 100 S CEDAR AVE, PO BOX
242, VALLEY CENTER, KANSAS 67147
(name and address of firm)
to remove the above identified body from the State of Kansas for final disposition*
Issued by:
(signature of funeral dire,46r and address) 100 S CEDAR AVE, PO BOX 242, VALLEY CENTER, KANSAS
67147
Embalmer: ROY E BROCKMEIER 2615
(name and license number)
This 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 disinterments.)
*When the body is to be cremated, a Coroner's Permit to Cremate a Dead Body is required in addition to this permit.
VS210 Rev.09/01/07
I
aW
Kansas Department of Health and Environment
Center of Health and Environmental Statistics
Office of Vital Statistics
1000 SW Jackson, Ste 120
Topeka, KS 66612-2221
Out -of -State `transit Permit
Full name of decedent: ALMA LOUISE VANSKIVER Age: 86 Sex: Female
Years
Date of Death: 09/23/2011 Place of Death: WICHITA, SEDGWICK County KANSAS
(city, county & state)
Point of final destination: BLAIR CEMETERY
(name of 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:
Funeral Director: JEANNNNIE VOLES 4844
(name and license number)
Date Issued: 09/30/2011
Funeral Home: BAKER FUNERAL HOME -VALLEY CENTER, 100 S CEDAR AVE, PO BOX
242, VALLEY CENTER, KANSAS 67147
(name and address of firm)
to remove the above identified body from the State of Kansas for final disposition*
Issued by:i s
(signature of funeral dire & and address) 100 S
ff 67147
Embalmer: ROY E BROCKMEIER 2615
(name and license number)
PO BOX 242, VALLEY CENTER, KANSAS
This 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 disinterments.)
*when the body is to be cremated, a Coroner's Pernit to Cremate a Dead Body is required in addition to this permit.
VS210 Rev.09101 /07