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Wood, Muriel NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Biostatistics-Vital Records Section »: Name First �_ Middle Last Sex / azaG'-C% giii Date of De ;::.A :::: ` If Veteran of U. .Armed F rces::.:::................................. _ :::»::>: - War or Date >Z Place of Death Hospital,�lnstitutiori� r � City,Town or Village to y, g Street Address i .:; f ...C...........of D h 14 is ertifie ame ��� ......................................::::.T'ifle:.�,... _, Address d r th erti icatt e. Di ict Num er Register Nu r City,Town or Village e etery r ematorysc,,t_ urial il:. ........6.7.-7.=:!?.,‘4-..V........................................1 .„,,a‘.6, ...hf.e.4-A.7. -- ❑Cremation A ess g. Date ace Removed ,! ❑ Removal and/or Held and/or Hold>:::::::::::::::::::::::::::::::::::::.:::::::::::::: ::.:::::,:::::::.:::.::. :::...................................................................................................................................................... Address Q. Date Point of n ❑Transportation by Shipment Common Carrier Destination ........:.......:::..::::.....:...:.....:::::::..::..:.....:::....:::.::..::::.::::::::::.....::......................................................................... ❑ Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address Permit Issued to c- Registration Number Name of Funeral Firm / t c Address , r r ) Name o neral Firm I ing Di et o hom . ...../7...g4........... ............./... .............................................................................. Z Remains are Shipped, If Other than Above Address ALE CV Permission is hereby granted to dispose of the hu n r a s escri above as Indicated. Date Issued .,__5 -,2,4 p� Registrar of Vital Statis' s �9 , 6 (signature) District Number ,SG/ Place J /-,cr./ I certify that the remains of the decedent identified above were dispos in accordance with this permit on: H w' Date of Disposition J �o5- - Place of Disposition T4�c� -; -y. c+ ( v� : sq.,,, 2: (address) J Err (seed �a S (t number) (grave number) AD Name of S n o Person in Charge of Premises Kee$nr e G , Y-Y`o c PL Z (Please Pant)w S' Signatur Title V .- DOH -1555 (9/86)p 1 of 2(formerly VS-61)