The URL can be used to link to this page

Christian, William NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name it t Middle Last Sex„ i Ijr� e4vi A� �r( Date of eath Age If Veteran of U.S. Armed Forces, Cl- /-C.- Vet 7 78 War or Dates l q..6"‘ -- 1 760 j- Place o eath !! Hospital, Institution or 5 Cit own r Village 77c AP- & Street-Address tkririlfe-eomno-b t�src ror7l Ali trj Gi- p Mann of Death ly.477INatural Cause 0 Accident 0 Homicide D Suicide El Undetermined EI Pending la Circumstances Investigation U. tu Medical Certifier 1>tr , e aATitle (174 0 Ad G ar T CO e-� - �jr I�& Death ficate Filed District Nu bpr- Cl Register N mber Cit , ow,r.or Village 1 Co p�P�t3c* �P�/ Date Ce - = or CreSnatory c ❑Burial �`��/�� r ,/ C)/eA) &.244 s9 03- ['Entombment Address Cremation L eQ9. .iVL Aiy-, Date Piao Removed ❑and/or Address Removal and/or Held r,;;; t'J Hold 0 Date Point of il` 0 Transportation Shipment a by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Z- C' f Re istration Number Name of Funeral Home ioA 14.A , l f ieep� ��mQ- Registration Address /4 11111 Name of Funeral Firm Making Disposition o"r to Whom Remains are Shipped, If Other than Above 2 Address tr tt P.` Permission is he eby granted to dispose of the human rem i describe' .o as indicated. Date Issued t2(/(7 1 r Registrar of Vital Statistics 1 \ oh\,\Q rn �� (s•:G• re) District Number 1_3(---lD 4/ Place I i c cto-i-c 3-A' eye certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z liii Date of Disposition 1//9//7 Place of Disposition2)')O- v Pitt/ 6/0-fi Lo / 7 2 / (address)Ili / Ul (section)re (lot number) (grave number) - 1I v)-1 Ct. tt a- Name of Sexto a in Charge of Premises it ►� _ (please print) la Signature Title C.,c- -ictkr © z4 10e/ (over) DOH-1555 (02/2004)