Dunphy, Francis 1
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics - Vital Records Section
Name First Middle Last ,
__-„,14,044. 4t,--
ce )._ i
7
Date of "atn Age If Veteran of . . Ar ed orc ,
./, , -75 p--, 7 ‘ ,-- War or Dates 0
.17 m ' . -- • •
,• Place of Death
, Hospital,
lu City,Town or Village /24.94.,e, .* ‘4...e12___ Street Address
. •
AU ........ . ". ................. ....-....................... ........... .. ..................... ... ..... .. .. .... .. . ............................ .
bea. .-6/.- icate-bFile...... d ss
6z,e - ,A'./ Register Number
i:m ..........., . ..... . _,.. .... '. .. .... .... . ........... ............................................. . .
fFi - istricrN um
City,Town or Village ,,,/ , , /Le.4 .
_ --tie)/ ,.Z4- ----
.13-5 Cit tetfuy or Crematory
E•if
unal
L.. ... ....7:./... ..•.-.-.f.7........................... ... ...a.,ex.. .. . ...
r s
0 Cremation _
0 /
• • .
Z i, te Place e 0 Removal il
7m
: a Heldoved
Address
-
1- and/or Hold i.-.
ci)
0. Date Point of
(I) El Transportation by :
- Shipment
CarrierCommon
Destination
. .............................................„ . . . ...................... . ............................ .... ...................................... . . ........... ........ .. . .................
Date Cemetery Address
0 Disinterment
................................................................................................ ....................................................................................... ... ................................... ....... ....... ....
Date Cemetery Address
.....:, 0 Reinterment
• •
Permit Issued to Registration Number
liName of Funeral Firm ) - ,,...4.„?. .."... .'7.. ., .:?f....-. 1.6,iii,r-7 TT..................61,149„7..... . ..
i'i!i0. _Al. .... . .....4..,.... .
...,,,„„, Mme Funeral Firm ispo Mon or iofi.-... om
Remains are Shipped, If Other than Above
la
- ..
Permission is hereby granted to dispose of the dead m re ains de cribed above as indicated.
Mi Date Issued /, -/ -1-7 Registrar of Vital Statistics .
.........
signature)
District Number .5 6e/ Place .(c__zic./4 ' )
..,"
I certify that the remains of the decedent identified above were dispo/• of in accordance with this permit on:
i-
Z Date of Disposition 10-19-87 Place of Disposition Pine View Cemetery Queensbury, N.Y. 12801
ui
2 (address)
LIJ Free Ground 40
tt (section) (lot number) (grave number)
0
0 Name of Secton or Person in Charge of Premises Rodney G. Mosher
Z (please print)
UJ ..4
Signature Title Supt.
DOH- 1555(9/86)p 1 of 2(formerly VS-61)