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Caruso, Camille
0PO NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit gli Name First Middle Last Sex Date of Death Age If Veteran of U.S. Armed Forces, A ` a . ©0(o OD— War or Dates A 'lace of Death Hospital, Institution o ��^^ :..b City,Rewn.ef Village La_ , G T Street Address ' Ll. ■.S` :,,� Manner of Death kakillicirNatural Cause El Accident 0 Homicide 0 Suicide FlUndetermined El Pending Circumstances Investigation Medical Certifier Name Title Address 111. 1v . 1t 6 0 _ S; . ... • 8-0 Death Certificate Filed Distil t Number % Register Number City,Fewia Village - : -S ,0 Date - - -� - - : Crematory • ❑Burial �: I. • a . ►► :i10' .` Ad.ress ::: Cremation 0110i. [ IR Nrli G . .- - w t_ I' • . Date "lace Removed a❑Removal and/or Held .•• and/or Address Hold 0 Date Point of N0 Transportation Shipment 5 by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home L. IL, L ■.au ; , # 0 0 ni Address ` 0 0 " Name of Funeral Firm Making Disposition .r to Whom ' ... Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains des ribed- abov/ as i ed. Date Issued / 6 d t Registrar of Vital Statistics � �' (signature) >< District Number ,S60/ Place „,_0,, if;L. — I • ' Z I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ilifDate of Disposition/4 Place of Disposition / j I/ -1C/ C .M4)df Z t vA a (addre 1'�ss) In CI (sef�ii^on) numbbeerr)l� k (grave number) AName of Sexton or Person in Charge of Premises L� Z- g (please print) . W Signature (/,,A., .., Al Title ,. ��i_ (over) DOH-1555 (9/98)