McArthur, Christopher NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Sex
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Date of Death '. Age If Veteran of
lia7. 7 .,.3 ................i...... War or Dates
::i2 Place of Deaih Hosphal,'Institutior
U 1
A City,Town or Village....70,.0..k ,Kee.„..\„, Street Address (9k..g5(p..1 i I
(-)k GitfT\ C2k.1-67
,:1 oause oi Deatp_,l
(.....10.(.4.‹,,. 4 LA' (-1.-.1\i'VfL...o-e-.0_
Medical Certifier Name Title ..........--- •••••••••••••••••••••••••••....-----•••••—•-••••••••••
Address ZJ
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- Death Certificate Filed District Number Register Number
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.... City,Town or Village rbk_vx Ce 097 . i `SA C1 n r) f- ( I qe--- )
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Date -,..) i Ce etery or Cremato
0urial
Address--- 1 -,o-- • „..
A ,----.
0 Cremation ii
(. 0 CA_e_o_—_, b _ A •
.......
Date ;: Place Removed
0 0 Removal and/or Held
1..... and/or Hold ir Address
•
Date Point of
tn EI Transportation by . i. Shipment
6 Common Carrier
Destination
•
. . .. . . . ...
Date ........ Cemetery Address
.....:-.: n Disinterment
L...1
••
Date Cemetery Address
- 0 Reinterment
Permit Issued to Registration Number
.........
Name of Funeral Firm . 0 t6----Cal-
..-
•••• Address
Pct-tk.
....
Name of Funeral Firm Making Disposition or to Whom
sia Remains are Shipped, If Other than Above
• „ . . .
Address
14
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,
Permission is hereby granted to dispose of the human r ains described ve as indicated.
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M Date Issued e- ,.9i---Ff--- Registrar of Vital Statistics A,Iat-k a.i!,....— I ....,,)/T,
(signature)
!..-.:
..... •• District Number c Co 5 ) Place kl-,
.-
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. - I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 8-7, //Tr Place of Disposition S -e l''-14 iti eDer 1,c/1,4461/.0i
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-2 (address)
Ur Okleite1P1 01,1k0ii./i/ Gil ,f a 41",--)
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.CC- (section) (lot number) (grave number)
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p Name of Sexton or Person in Charge of Premises a r ;n.ri,
Z (please print)
1.41 •
771%CitAlc. 7,141"-----
. - Signature Title ()Pe 4 i 4) cjr
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DOH-1555(9/86)p 1 of 2(formerly VS-61)