Collier, Edith ti
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records sew Burial - Transit Permit
Name rust , `�"`�`..1 Sex
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Data of Oeat� I tf Vehiran Of U.S.Armed Forces. 1
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• of oea00ialtial tame Q ['Homicide 0Suicide 0 undetenuim®d 0 Penang
Circumstances cumstances Investigation
Medical E Maier Name 69-(1..Soy.)
Tim,
ih9AJi62 /I i)
Address / �..3 �Y1 S%. e(.1.�`,._)s t - �U / 2,el)
r : Distr Number Register Number
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V Town or age Ct 6^'S Folk c /-69/ 9S�
CrematoryI kV 2 /6/0 6, RAc,- lie 6--i--)
❑C remebon Address U 'I�C� (BL S$ (1
Date Place Removed
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1" Hold
Dab
Date Pairs of
■Tvir>raporSlimed •
a by Common DesOnadon
Caner
0Dis enner,t Date Cemetery Address❑Reintamr>terrt Date Cemetery
Pernik Issuea
Registration Number
Neale of Roodto Hon fkkt ,ryiv-el r)- a...kr r.+unea-cd 1'iO,r►tie. Y'
Address i1 Lot Paye st • t'i tteratotyi kg. P-01
Name of Amaral m Mai Disposition or to Whom _.
Remains are S rped.K Other than Above • .
AddUefss
Persian le to depose of the human remains. aIs
Date issued 0 5 r O Registrar of Wel Mastics
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Distrir t Number 'J�0/ Pierce ram/ 'a 1 ; /J
I caddy that the nemeeirtis of the decedent idended above were deposed of in accordance with this permit on:
[� oe�id� 3/6/06 Place oforr PTrvF VJFW FMFTFRY.nIIFFNCRfIRY NY
F�; (address)
MOHAWK 169 1
,' (secUon) got nunther) (grave number)
a' Name of Sexton _or in Charge of Premises M T r H A F I G F N r F R
. (please print)
We SUPT,
(over,