Crannell, Murray - NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics - Vital Records Section
.- Nan‘ Fi Midd2/ Last i Sex e--
Date áf atf<64-44 ---A-ge) If Veteran of U.S. Armed rrces,
7,‘ War or Dates
Place of De th Hospital, Institut' r
44.1 City,Town or Villa Street Address ,
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:J:). use of Death . /1
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:ioi Death rti icate Fi ti. rict N er . 'Register Number
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lig City,Town or Village -,..,ALe ‘,11 V---
Oat ddeC pi or Crem ry
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El Burial
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mation l' ,
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Z ate ... Place Removed
O 0 Removal and/or Held
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1.- and/or Hold ...
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O .. ... . . . . . . . . . .
IL Date Point of
0 Ei Transportation by Shipment
O Common Carrier :i. Destination. .. . .. . . .
Date Cemetery Address
0 Disinterment
Date Cemetery Address
0 Reinterment
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Permit Issued to Registration Number
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Name of Funeral Firm P( e.-(21 _
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:44: Name of ne irm eking ho
* Remains are Shipped, If Other than Above
.Ct• Address .
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Permission is hereby granted to dispose of the dead IM re 1 descrlb d above as indicated.
; ..-...i.- Date Issued -- 3 o '.- --7 Registrar of Vital Statistics
signature)
District Number L 5--E.0 7 Place .. , .9,t7„,..6. "'...2 — (
I certify that the remains of the decedent identified above were disposed of in. dance with this permit on:
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Z Date of Disposition ..1-4 €r7 Place of Disposition Jo t-t) 0-i (f)(.. A
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Z (address)
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in
CC (section) (lot number) (grave number)
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0 Name of Secton or Person in Char e of Premises ,o'Q,IX/ //qt.)-1- S
Z (please print) ‘
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Signature _....., --s__.-4___„, Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)