Valvic, Beatrice NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
�■
iiiiiii Name First Middle Last I Sex
84./a BEATRICE VALVIC FEMALE
Date of Death Age If Veteran of U.S. Armed Forces,
iMi 10/31/96 72 War or Dates NO
Place of Death Ha3pital, Institution or
City, Town or Village PLATTSBURGH Sty-et Address CV/PH MEDICAL CENTER
Manner of Death a Natural Cause 0 Accident n Homicide 0 Suicide ❑Undetermined 0 Pending
Circumstances Investigation
ra Medical Certifier Name Title
I NOEL WOLKOWITZ M.D. —
Address
iM 206 CORNELIA ST. SIUTE #)&, PLATTSBURGH, NY --!
-.•c^_`� Certificate Fi'.sd
District Number Register Numbe-
Cii, Town or Village PLATTSBURGH 901
.--___e Cemetery Crematory
17.7.:7___1� cr Cre,.-ate:Burial 11/1/96 PINEVIEW CREMATORY
Address
- - -. CaaLI:iicti", QUFENSEUFFY, 1 Date Place Removed
g 7 Re:noval and/or Held
c�
1 Address
Fold
. Date Pont of -1
v Transportation Shipment
Ei by Common Destination
iiiii Carrier _
Disinterment Date Cemetery Address
Reinterment Date Cep netery Address
Permit Issued to Registration Number
Nii Name of Funeral Home W.M.MARVINS SONS INC. 01220
in Address
iM ELIZABETHTOWN, NEW YORK 12932
ni
ni Name of Funeral Firm Making Disposition or to Whom
It Remains are Shipped, If Other than Above
Address
W
a
'> Permission is hereby Granted to dispose of the human r in ribed , d4ye indicted. (-
ia Date Issued 10/31/96 Registrar of Vital Statistic j� 4-if •
(signa ure)
District Number 901 Place CITY OF PLATTSBURGH.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
/ �' — ,9T iii Date of Disposition/l�`9f� Place of Disposition / N�' / � ��/ ��
2 (address)
ILI
CC (section) n n,, (lot numbery (grave number)
GName of Sexton Person in C rge of Premises , OG�/Wri.) "/97 �4
please print) � t
t4 Signature ``! • Title ��k—/rd7;9/ li-",--> / `
DOH-1555 (10/89) p. 1 of 2 VS-61