Bodenhorn, Donna DEPARTMENT OF HEALTH OF THE CITY OF NEW YORK
BUREAU OF VITAL RECORDS
Q, 16057 BURIAL—CREMATION--TRANSPORTATION PERMIT
Date DEC 1 0 197�3
The Certificate of Death, ving been furnished to this Department, as required by the Health Code, permission is
hereby given to_ _ o� f- l
'
to remove the remains of _. .. -.. .G � � -_._...Age 2. __Yrs. ...._._.Mos. _._.......Days,
who died at..-. - t .._,k4 - - ._.._ Borough of Queens,
City of New York, on._...J .=___ f ,l92? 3. j/
Croy*for
i--��� �
for Burial*at_../4,1i4' �.__ �� x'C %fv-f on /2 - / 2- 19 73
This permit must be handed to the Keeper / Z ` ,, e►'sl er"a'
of the Cemetery or Crematory by the -
Funeral Director in charge of the funeral. City Registrar.
*Cross out one. Per ... _.._ __.e. ..._ _
1HH-35M-705500(72)dap.346