The URL can be used to link to this page

Castaneda, Jane i 't -It c---5 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit iiM Name F. 5.t .. Middle L t Sex Rit Dat of Death Ag If Veteran of U.S. Armed"Forces, IN (/ O )c'/ 7 ��. • War or Dates Plac-f. Reath' �� Hospital, Institution or City. Town or Village �/ Street Address • Mann of Deathatural Cause 0 Accident 0 Homicide 0 Suicide ri Undetermined El Pending Ifs Circumstances Investigation ril Medical Certifier Na e /� Tit ,,, �, �itam,Il �'� � il-.......... /7 Cris S ,„aAddress r9// /c.,,i7oaki �Z/ /F/ <° Death C ificate Filed District Number Register Ny <> City, ok or Village ��jeS -P�- - 9 2 C etery or Crematory �-- s ❑Burial Da�� I//c(/ 0��'�? nil 1 -eGtJ�/-el�T�r/U!/rO L''-1 Addre ::: remation C ✓ -uC e /� , �� Q� Date Place Removed 0 El❑Removal and/or Held k and/or Address = Hold Q Date Point of NQ Transportation Shipment 5 by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address 's.iii Permit Issued to �,/,// Registration Number s> Name of Funeral Horn 6:_ I!`/97 -///7e "-,7 7 ':/ ,/ - G d©/y� Addr s 1 r pm., ,(T_ it,,,,cle,. 7 X-,e_ie >/.7/--7- /g)--r/7 .;.„:; Name of Funeral Firm Making Disposition or to Whom , Remains are Shipped, If Other than Above Address liti iti :iili:iiii Permission is hereby granted to dispose of the human re ini described above as indicated. kili in Date Issued ' ,`A- O CI Registrar of Vital Statistics 64(k}-0--a_ (si nature) <' District Number 5(5"-a Place l bui,n. c C C, fle__S k_V' iiiig I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f-ti ( i'�'"IY` P Date of Disposition $/31�1� Place of Disposition ,Ii - 6"vc 2 (address) ifl LE (section) numbe (grave number) Name of Sexton or Person in Charge of Premises 6,(lot rsi 1-10• g (please print) U. Signature ,t Title /PP hi N'f- (over) DOH-1555 (9/98)