Mabb Jr., Edward III
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name # Sex
r war J b Jr. . male
• Date of Death Age Fc. _
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`7—/L1-oCo r71 Ww or Dates NA
Death
hw Townor1 geG 5 Fa y titution�G(�s Fai I
v'x. - of DeathliOatlaW Cause OAccident 0 Hondcide 0Suicide 0Undetermined 0Pe, ,g
- Circumstances Investigation
4j Medcat Certifier Name P`qee A a G t 11cx n\ TM M,D
t, Address
02 -Pat1__ S S T-al1S 1Je;,,IVuc-� RAQ )
• I Certificate Feed
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s Date c _. _ or Cre
.•. ' Entombment Address
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Z 2 Date Place Removed
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❑Removal a Hera
w Hold
Date Point of
sK• ❑TmnSpOrtaliNi
by Common Destination
Carrier
p Disinterment Date Cemetery Address
Kcr —Date Cemetery Adcfress
0 Rekterment
-, Pernik Issued to Registration lkharter
r'' None Funeral Home mftrvii Kt 1). KE1 - FU.I1t7&AL I1-oHC C01I gq
t.,' address
1/ Li-FPi / T`rC t ( Ltezn)s6a.121 ice/ iz Y 04
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Name of Funeral Finn Making D osition or to Whom
Remains are Shipped If Other than Above
t. , Address
i> :• Permission is to dispose of the human remains above . :_
h YY'lI •
Date Issued ®> i 7 0 6 Reg�tar of Wei S �
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District Number SIO/ Place z,,,,,„,,,, /---A15, ,ev
I certify the the rem of the decedent identified above were disposed of in acconiance with this per it an:
D eot Dsp 7/18/06 FiacedDisposition PINE VIEW CEMETERY,QUEENSBURY NY
'•' :` MOHICAN 5t 1
•
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i . got number) (gave number)
Name Sexton pars f 1 MICHAEL GENI
��a�X. Title SUPT,
(over)
DOH-1555 (02/2004)