Yanklowitz, Louis NEW YORK STATE DEPARTMENT OFHEALTH ��U��~%�� � ����h����~� �����Q��~�
Bureau ofB�o��o �s'Vho Records Section
��~," u=~m Transit Permit
PermissionName First Middle Last sex
te o el�
War or I
Place of Dea// ?a,
Hospital, Institution q
City,Town or Village Street Address
City,Town or Vill
F1 Cremation
E] Removal
and eld
and/or Hold
Address
Date Point of
M.
rtation by..
Shipment
Destination
Date Cemetery Address
171 Disinterment
Date Cemetery Address
Registration Number
Permit Issued to
Name of Funeral Firm
Remains are Shipped, If 0 her than Above
U.
^ Is ^~'~~v w`~^^~~ to ~'~r~~~ of the ^~^'
Date Issued Registrar of Vital Statistics
District Number Place
I certify that the remain�of the decedent identifi d above were disposed Of/in a ance with this permit on:
Date of Disposition ///;'(/AC1Place of Disposition Q r�x C --ki
(section) (k)t nuQr (grave number)
.E� Name of Sexton or Person in Charge of Premises
(ple2p/rint�
Signature Title
DOH'1555 (90G)p1of2(formerly VS, 1)