G 15684
PERMIT FOR DfSPOSSTEOM OF HUMAN REMAINS
3<*7?cffl')
PERMIT NUMBER
NAME OF DECEDENT
Rev* Soon Hyun
DATE OF BSRTH
March 21, 1878
DATE OF DEATH
August XX,1968- M- 90
PLACE OF DEATH-CITY OR TOWN
Los Angeles
PLACE OF DEATH—COUNTY (OR STATE IF NOT IN CALIFORNIA)
Los Angeles
NAME AND ADDRESS OF SPOUSE OR OTHER INFORMANT
Pet-er Hyun
NAME OF FUNERAL DIRECTOR (OR PERSON ACTING AS SUCH) j CALIFORNIA LICENSE NUMBER
Forest Lawn Hollywood Hills Mortuary j F 90U
3367 3/U Hamilton Way
Los Angeles, California 90026
1. BURIAL (INCLUDES ENTOMBMENT)
2. CREMATION AND BURIAL (INCLUDES INURNMENT)
3. CREMATION AND BURIAL AT SEA
TYPE OF PERMIT. CIRCLE ONLY ONE OF THE FOLLOWING TYPES OF DISPOSITION
6. DISINTERMENT AND BURIAL (INCLUDES ENTOMBMENT)
)
10. DISINTERMENT AND REINTERMENT OF CREMATED REMAINS
(INCLUDES INURNMENT)
7. DISINTERMENT. CREMATION. AND BURIAL
(INCLUDES INURNMENT)
4. CREMATION AND DISPOSITION OUTSIDE CORPORATE CITY
LIMITS. AND OTHER THAN IN A CEMETERY. AS PROVIDED
IN HEALTH AND SAFETY CODE SECTIONS 7054.6 AND
10376(C).
5. SCIENTIFIC USE
8. DISINTERMENT. CREMATION AND DISPOSITION OUTSIDE
CORPORATE CITY LIMITS. AND OTHER THAN IN A
CEMETERY. AS PROVIDED IN HEALTH AND SAFETY CODE
SECTIONS 7054.6 AND 10376(C).
9. DISINTERMENT. CREMATION. AND BURIAL AT SEA
11. DISINTERMENT OF CREMATED REMAINS AND BURIAL AT SEA
12. DISINTERMENT OF CREMATED REMAINS AND DISPOSITION
OUTSIDE CORPORATE CITY LIMITS. AND OTHER THAN IN
A CEMETERY, AS PROVIDED IN HEALTH AND SAFETY CODE
SECTIONS 7054.6 AND 10376(C).
FOR VHE PURPOSE OF ISSUING THIS PERMIT. DISINTERMENT IS DEFINED AS THE REMOVAL OF HUMAN REMAINS FROM ONE SPECIFIED PLACE OF DISPOSITION TO ANOTHER SPECIFIED PLACE
OF DISPOSITION. COMPLETE EACH ITEM REQUIRED FOR THE TYPE OF PERMIT SPECIFIED ABOVE AND ENTER 'NOT APPLICABLE" IM EACH LINE NOT REQUIRED FOR THE SPECIFIED DISPOSITION.
CREMATION
INTERMENT
AFTER
CREMATION
BURIAL AT
SEA AFTER
CREMATION
DISPOSITION OUTSIDE
CORPORATE CITY
LIMITS. AND OTHER
THAN IN A CEMETERY
AS PROVIDED IN
HEALTH AND SAFETY
CODE
SECTIONS 7054.6
AND 10376(C).
SCIENTIFIC
USE
NAME AND ADDRESS OF CEMETERY WHERE REMAINS ARE TO BE INTERRED
NAME AND ADDRESS OF CREMATORY WHERE REMAINSpAR£#) ^5fWffPe!
Forest Lawn Memorial Park,Glendale,Ca«
DATE CREMATED
JUL %L \??A
SIGN/VR"
gOPK
COUNTY
Person in charge of crew
Y.P. Opoi. By-,
v..*.Tr!2v
cflqc^T t^WN MEMORIAL-PARK ftSSOC.
NAME AND ADDRESS OF CEMETERY WHERE REMAINS ARE TO BE INTERRED
Korean National Cemetery! Seoul, Korea
BOAT OR AIRCRAFT
NA
BURIAL AT SEA
NOT LESS THAN
THREE MILES FROM:
NAME OF NEAREST POINT ON SHORELINE
I COUNTY
TJ,
:«A
DESCRIPTION AND ADDRESS SUFFICIENT TO IDENTIFY FINAL PLACE OF DISPOSITION
NA
I
NA
THIS IS TO CERTIFY THAT I AM THE PERSON HAVING THE RIGHT TO CONTROL THE DISPOSITION OF TW
ACKNOWLEDGMENT REMAINS OF THE ABOVE NAMED DECEDENT UNDER PROVISIONS OF HEALTH AND SAFETY CODE SECTION
OF
APPLICANT
THIS PERMIT GIVES NO RIGHT OF UNRESTRICTED ACCESS TO PROPERTY NOT OWNED BY ME.
7100. AND I HEREBY ACKNOWLEDGE THAT TRESPASS AND NUISANCE LAWS APPLY AND UNDERSTAND THAT
NA
SIGNATURE OF APPLICANT
NA
DATE SIGNED
NA
NAME AND ADDRESS OF FACILITY RECEIVING REMAINS
MA
THIS PERMIT IS IS5UE0 IN ACCORDANCE WITH PROVISIONS OF THE CALIFORNIA
HEALTH AND SAFETY CODE AND IS THE AUTHORITY FOR THE DISPOSITION
SPECIFIED IN THIS PERMIT
AMOUNT OF FEE PAID
2.00
DATE PERMIT ISSUED
&A g 3 1975
1 CERTIFY THAT THE SPECIFIED DISPOSITION WAS MADE 0N_
(ENTER OATSi
S»GNATuS&OJi LOCAL REGlSTRAT^lsSUlNG PERMIT
%
SIGNATURE OF PERSON IN CHARGE OF CEMETERY OR OTHER D1SPOU
7nPY lOF THE PERMIT ACCOMPANIES THE REMAINS TO THE STATED PLACE OF DISPOSITION. THE PERSON IN CHARGE OF DISPOSITION IS RESPONSIBLE FOR COMPLETING THE PERMIT AND FORWARDING IKE CC*
fOfirlD PERMIT WITHIN 10 DAYS TO THE LOCAL REGISTRAR OF THE DISTRICT IN WHICH DISPOSITION OCCURRED OR TO THE LOCAL REGISTRAR OF THE DISTRICT NEAREST THE POINT WHERE THE CREMA.lfl ...
PLETED
MAINS WERE BURIED AT SEA
COPY 1
STATE OF CALIFORNIA-DEPARTMENT OF HEALTH-OFFICE OF THE STATE REGISTRAR OF VITAL STATISTICS
(REV. 7-U73) FORM VS i-
