Abbott, Rozellah NEVVYORK STATE DEPARTMENT OFHEALTH ��00�~��N ~ ����)����~� ��"��N��~�
/^ Vha| R000�eSec�n �~~~~ ~~~~ ~ ~ ~~~~~~~~ Permit
Name First Middle Last Sex
Rozellah Abbott Male
-'��--e of 6~-'--^-~-'-~'~~-^--' ~—`-----'Age Vv"������'���.����� ----------------------------'
8-9-90 75 yrs. War or Dates Yes WWII and Korea
Z. Place of Death Hospital, Institution or
:W City,Town or Villa. Street Address Hall1flark Nursing Centre
Manner of Death Natural CauseE] Accident E] Homicide 0 Suicide Ei Undetermined E] Pending
..... Circumstances Investigation
-'Med-i'c-a-l- -' ....
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Thomas Kandora. ND
~-`^-~~~~
Address
7240 Upper Broadway, Fort alward., NY 12828
~~~~-`~
...... District Number Register Number
Death Certificate Filed
City,Town or Village
Date Comote Crematory
DOBurial 8-11-00 Pine View Cemetery
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�]Cnanndon Bd., Voeecsbucy" UrlZ804 - -'
z Date Place Removed
0 Removal
and/or Held
Fn
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IL Date Point of
Ln
[:] '' sp" a"" ' "y Shipman
Common Carrier ----------------------------'-----
Destination
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Address
/ �lDisinterment --- Cemetery
- ��
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Address
Reinterment --- Cemetery
�- Permit�
Jams F. Singletonjnc.
01850
Name of Funeral Firm
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Remains are Shipped, It Other than Above
Address
Permission is hereby granted to dispose of the human O�ains described a v as Indicated.
Date issued 8-10-90 Registrar of Vital Statistics
District Number 5657 Place Tom of Voaeoabory. 0Yl2804
� I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date ofDisposition Place ofDio \/
2 (address)
Cn
cc (section) (lot number) (grave number)
Namo
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