Catanzaro, Stephen r ./YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First n Middle Last S x
T t�P .� r, C97,6,1/4.)a ,/�GrZla�
'- Date of Death Age If Veteran of U.S. Armed Ford
/1 /3 Z> A t o 9 if c. i S ar or Dates n J 67-
of Death Hospital, stitution or
own or Village CL ,vs F�ZL S reet Address (;I&^,J s 1-292?S
`„, Manner of Death'Natural Cause 0 Accident 0 Homicide D Suicide I=1 Undetermined Pending
Circumstances Investigation
til Medical Certifier Name \ Title
Address
e
3 �F` ILo,.j Ci4k 1 6 �L. _ C't.CA S I ,S Ail',
l''
•--th Certificate Filed DistrictFt\/ R Iste umber
1 own or Village t; S fu r _ r
Date <Cemeterelmatory
gBurial /Z e/ 0 (-n /..s e U ftA-J
_A_ddre_ss
Cremation 047CtiL. le.,00-0
/V �L 11 L
Date / Place Removed
❑Removalkij and/or Held
t= and/or Address
Ei} Hold
0 Date Point of
N❑Transportation Shipment
E by Common Destination
Carrier
>: Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to _ Registration Number
= Name of Funeral Home na , , N 1• Rotes f—u,,4;utt„ Miic ®j)q t/
Address
Ay: i le—d if
igii Name of Funeral Fri Making Disposition or to Whom ' ' -
ti Shipped,Remains are Shi d If Other than Above rtl
46 Address
uil
i
iiai• Permission is hereby granted to dispose of the human remains descri e• a. ..7 in d. _-
><. Date Issued /4//9 4 Registrar of Vital Statistics .'
(signature)
. District Number S 1/ Place aa�-4iyp ,--A, AV
NI
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
Lij Date of Disposition 1 7/4/n R Place of Disposition PINE VIEW C E M E T E R Y, Q U E E N S B U R Y N Y
;; (address)
CD ERIE 24-R 1
O (section) (lot number) (grave number)
iQ Name of Sexton or Person in Charge of Premises M T C'H A F I GFNIER
n (please print)
W Signatur �&,4X /J.�tiwt., i Title S I I P T
(over)
DOH-1555 (9/98)