Carroll M CarterCOZ
!A Z oI
pARTMENT OF HEALTH
cOLORAD0 DE ISpOSITION
1876 AUTHORITY FOR FINAL D constitutes authority
led out and bearing the required signature, below,
ermit, when completely filled state, or other authorized disposition of the deceased named
This final disposition p oval from, the state, accompany tl)p remains to the destination. jime 26, 1986
for burial, interment, cremation, rem
in accordance with 25-2-111 CRS. This permit mist
Date of Death
Carroll M CAIRTER..
Name of Decedent.--- Death Denver Denver
1924pia it
__--Male Age 62 Date of birth ce of De City county
Sex
N'ne of Funeral F--stabflshmen
IM--------
-k2--Q--ao- __Quql?ec, Dgnyer CO
_ _ a
Address of Funeral EstablishmentBlair_,,____.
Place city
a' cemetery or 5r—ernatorY
Type of Disp I osition ---R-e-M-0-v. it named above and authorize final disposition of the remains
examined the completed death certificate for the deceden 25-2-103 CRS in the county where the death occurred,
.1 have, shed pursuan to the coroner or the coroner's designee.) 0,
ted or established June 27, 190u
(r® be signed by the office desig Ith occurred,
I t in the count where thed
an office d
or if sq�h irtP A---0 tC V Date
--%(�ignature, Title (� " AI
y the cemetery or crematory4official.
Items below are to be competed
b. charge of the cemetery, the funeral director May sign as sexton.
Where there is no full-time person in In Lot °.-._--- Block Section
Body was Date ----
FIRM