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De Matties, Linda / 'z.27 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex F Lina0.. i.,. O Hcx o Date of Death l Age If Veteran of U.S. Armed Forces, 3 f(51 1 9- 2 War or Dates 14 Place of Death ospita Institution or _ ffiCoity)fown or Village C L-1-" ram- Streef Address LA.t� 1 o kt- - Manner of DeaNLNatural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending iti Circumstances Investigation ji.a Medical Certifier Name Title , Suzy - R.a-- hycicn Address I lQ I C.CX-, `) (D- bwk_i_i i --I t23O `{ h Certificate Filed F District Number 60 i Register Number City, Town or Village L�•1 i II Burial Date J`Z t Cemetery o Crematory p cv. ❑Entombment Address g-VCremation 0l.)„..L - -` i 0' ht t.A.Li, Ai-1 _ t2;Soy, Date Place Removed ❑Removal and/or Held 1 and/Holdor Address in 1 ` 0 Date Point of St 0 Transportation Shipment C by Common Destination iSii Carrier ❑Disinterment Date Cemetery Address ..❑Reinterment Date Cemetery Address Permit Issued to - Registration Number Name of Funeral Home -1-Q-A--- 1 \z- C» 13U Address 11 Lc _f©` e o_ S - . 3 CG Awt3t.NV,4 , 1\-1-1 i2 gc)\-k Ni Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above ," Address it i '` Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 3 1 i(,fI C 7 Registrar of Vital Statistics `, c.AA.Ary.fi i-�✓ (signature Iiiiiiiiii District Number S(,Q, Place 6 (D�s- ,,`\S 3 j, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ill Date of Disposition 3f 2/J/7 Place of Disposition P, Li j e,,,) Z.,/e.rra �y 'i��" / // (address) w Mt Ic (section) (1 t number) (grave number) CI Name of Sexton o er n 'n Charge of Premises J�1 t 2-� 6 -e 2 (please print) itii Signature Title L-se rtizl. -,— (over) DOH-1555 (02/2004)