Koski, Edward DEPARTMENT OF HEALTH OF THE CITY OF NEW YORK VR21 (1HH)44M-728017(79)
BUREAU OF VITAL RECORDS otino 346
M 21259 BURIAL—CREMATION—TRANSPORTATION PERMIT JA N - 5 t969
Date
The Certifica of Deathea having been furn• h
o this� Department, as required by the ealth C e, ¢ • is
hereby given to_/�C `.r' &J/U /�7' ____f 4/
to remove the remains
+of 2)1� �� . eb S/'E ._____Age �Yrs. Mos. Days,
who died at_..__.......fi _ w&..' -_c /....._.:_._.. _._.. Borough of Manhattan
City of New York, o - ,19
� •
IJAN ��9a,
resheefeeee*
for Burial*at_. i .e c on 9
1 AAi
This permit mu* be handed to the Keeper • ayYr
of the Cemetery or Crematory by the r .
Funeral Director in charge of the funeral. Cit
•Cross out one. Per.....—.....—........ Allon.la