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Parsons, Royal L t. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Nodal E. Parsons Male D 5eMR th An years If Veteran of U.S.1Armedg62 Forces, War or Dates I-- PI �f Death F Hospital, Institution or Ci�wn or Vi�XX Nisua�,°_,r;a Street AddressILI 11''g Van Antwerp Road a Manner of Death❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending C.) Circumstances Investigation Medical Certifier Name Title r e�wart A. Siivers Md Agg verview Road, Rexford, N, 12 B-13g`3 DV. Certificat?�ed District Number Register Number Ci ' wn or Vi X Cliska- 46i52 24 ❑Burial Date . Cemetery or Crematory i0/2uC�ta Pine View Cremator ®Entombment Address :::: ❑Cremation Uueensour y. Ny Date Place Removed Z Removal and/or Held r. ❑and/or Address : Hold fa 0 Date Point of 05 0 Transportation Shipment L3 by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to _ Regqistration Number Name of Funeral Home Singleton-heady Funeral Home Oi002 AWKess ' ; Lay Road, c.lueensbury, N `I Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address t iit �' Permission is hereby granted to dispose of the human remains described a o e indica ed. 10/1 t7/2006 Date Issued Registrar of Vital Statistics (signature) District Number465i PlacENiskayuna I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ill Date of Disposition Place of Disposition 2 (address) ill Cl) CC (section) (lot number) (grave number) IIName of Sexton or Person in Charge of Premises z (please print) W. Signature Title (over) DOH-1555 (02/2004) _-• -- -- - .,�y v.���r rJ-,ya LIUH!SFUNERALHOME PAGE 02 NEW YORK STATE DEPARTMENT OF HEALTH + a Vital Records Section F , Burial - Perm it rilt Transit9/ Name FirV Middle Last ( Sex a-,a;° � r=arsons I ;v1aie D 42 p t�t?' years AO, 7tF Veteran of U.S. Armed Forces. War or Dates f?cd-4 s3e2 pl;. . Death t Hospital, Institution or Ci'�, i' nor Vil�xx Jiskaya,7a 1179 Van.Antwer;,Rost ifl: • Street Address_ hrii Manner of Death EiNatural Cause El Accident 0 Homicide ❑Suicide ri 0 Undetermined ❑Pending Circumstances investigation r Medical Certifier N , e Title r;:l • dart A. Sti'ers Aid AggMerview Road. Rexford N i214?-l13Q9 D- ertiticst 7 District Number ' Register Number C"?,Tam) or Vi N',skayuna iiti5 24 DBuriai Date Cemeteryry or Crematory 1 ' i ,'i�,';t'�Gt6 I Pine view Crematory ©Entombment�jCidre,5g �.._ �. ----- _ ®Cremation _u><-_rysburj, N/ rl D t { Place Removed - ri Removal Land/or Held andlor Address— ,uM___ Hold ��` Date I Point of Lr L j Transportation t 1 Shipment by Common Destination Carrier Disinterment Dale I Cemetery Address ri Reinterment Date } Cemetery Address . 1 Permit Issued to l ReAistration Number Name of Funeral Home iris etor-healy Funeral? Home i 7682 Ay.��y��,� s A+t• % av Road, 4l!eertstury, N Y Name of tneral Firm Making Disposition or to Whom ry 4" Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described a o e indica ed. Date Issued ht� G'lt�3f1 Registrar of Vital Statistics C~ (sigrlarure) District NumbertE52 Plac+ iskeyurta I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Ik/10/6, Place of Disposition R,,z:.t(J (-tic,-r._ct Gil i'In- (address) (section( (lot number) (carve number) P"`, Name of Sexton�Person in Charge of Pr raises _ ( h,r.s sr -e - (pleAsa print) Signature iril L, 'Title `'�^-41.c( (over) DOH.1555 (02/2004)