Lewis, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics-Vital Records Section
Mi Name First Middle Last Sex
ig.::<; DorothyB. Lewis Female
»r
DeathiM Date of Age If Veteran of U.S.Armed Forces,
"' 1/22/89 77 War or Dates No
Place of Death Hospital, Institution or
;ittiw City,Town or Village......... .... 9 Schenectady, NY . : Street Address Ellis Hospital, Schenectady, NY
.. Cause of Death
iitProbable acute myocardial infarction
iii Medical Certifier Name Title
CBong._:K.::.Yee : :: M�.......................................................
Address
1545 Chrisler Ave. , Schenectady, NY
Death Certificate Filed District Number...........................:.....:. Register Number
City,Town or Village Schenectady, NY 4601
Date Cemetery or Crematory
®Burial
6/21/89 :::::::::Seeley Cemetery'..:::::....:.....
0 Cremation
Address .. ... .........:..:...........................:.:.:.:.::::..:::..::::::.:::..::::
Queensbury,. NY
Date:::::....................:.......................................... .. .......... .......................................................................................................
.................... ..........................................::::::::::::::: :,::::::..........::::::................................................................
Z Place Removed
O ❑ Removal and/or Held
and/or Hold>::::::::::::::........:...............................................................:....................................................................................................................
Address
in
.....................:.............................................................................................................................................
0- Date Point of
U) ['Transportation by Shipment
Common Carrier `>
G Destination
El Disinterment
Date Cemetery Address
❑ Reinterment : Date Cemetery Address
Permit Issued to Registration Number
iiIii Name of Funeral Firm Andrew Funeral Service 00051
Address::::::................................................................................................................................................................................................................................................
242 McClellan St ,....Schenectady, NY....................................................................... ..
Name of Funeral Firm Making Disposition or to Whom
>j Remains are Shipped, If Other than Above
lIt Address
Atli
Ai
Permission is hereby granted to dispose of the human remains cribed above as Indicated.
(iN Date Issued 6/20/89 Registrar of Vital Statistics i�J�` —
signature
District Number 4601 Place Schenectady, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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w Date of Disposition�o� //y_ Place of Disposition ,$ '�fel G E/Y7 �P��)� dcted
2 J address) ,�i
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co ( (lot number) (grave number)
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p Name of Sexton or Person in Charge of Premises �_____��� 6/'' /A 4/ L1 6 e_
Z r (p ase print)
Signature G Title dPe7 6 cr-lff..._----
DOH- 1555(9/86)p 1 of 2(formerly VS-61)