Harrington, Francis NEW YORK STATE DEPARTMENT OF HEALTH /4
Vital Records Section s Burial - Transit Permit
- Name Fist MiddleLast
Fr2.Jc i & L, /I pvv AJc; TvAi
Date of Death Age if Veteran of U.S.Armed Forces,
Lf icr'16 (, 93 War or Dates .4 6
�Toa�rtt .I, �? v�..%s Q Li Saes--�- iron or /
1 Addrr 7 (49, �o i/Jc .2-7 &)o L./etc i
i al case 0A�� imorricide Q suicide p Undeterminedl
Circumstances Investigation
'9nMedical CoWe
:i'l Address
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• Death District Register umber
ma`s? 3 0
sir. � Vitla�e Q ue-�.as Q v n�
« ,■Burial Date
q X 0 4 Cemetery oCiii ----0— I /
„ Ilkbremation 6140i9-7/0,\.. At3 6 Ug2.;;JS'ig LrYZ- Aiy /Leo y
tQa Date / Place Removed /
and/or Held
Hold
* Address
; 1old Point Date . oR R a
• ['Transportation Sent
:: by Common Destination
• Carrier
p Disin erment Date Cemetery Address
io1eirmennent Meet Cemetery Address
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« Pemd Issued to traticxt Number
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// L -- /6-�-r&,-- S . Q r� u1, . 1 2-�-o
i � ,
Funeral
Firm tv.Mp- .mMon or to Whom
.If Other than Above
Remains
Adams
, Permission is hereby to dispose of the described as tea.
Via, - /
,�k Date y—��- �� of vied
t
• District Number cl,,c 7 Place Cc,Le
X I certify that the runs of the decedent identified above were disposed of in accordance with this permit on:
Y Date of Disposition `/- /O-t?(e Place of Disposition /- i 45 I!!,aft/ C4' .4 !Z l ✓L-1
(seam) ibtnI.i (grave number)
' Name of Sexton or Person in urge of Premises G $ tLJ( 6. _
A• S (13 rele CR1744 4 f' IL
tower)
DOH-1555 (02/2004)