Mills, Doris NEW YORK STATE DEPARTMENT OFHEALTH ��NN�~��N ~ ����)����~� D�^��8��~�
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............................................................................................;......-.......... ..........................��=~� �°=� Transit Permit
Name First M' le L—ast Se
..........
Date of Death
e If Veteran of U.S.Armed Forces,
War or D�o
M Place of Death Hospital, Institution or
:111. City,Town or villa"WOGA SPRINGS Street Addres
Manner of Death Vn.Natural Cause Accident El Homicide El Suicide E—] Cn e ermin F
.'di Medical Certifier Name Title
Address
Death Certificate Filed -t
City,Town or Village Sj4T6 G A SPRINGS
332
4501
Date Cemetary cjr Crematory 4/
*remation Address
z Date Place Removed
0 F1 Removal and/or Held
Date Point of
Ln E]Transportation by Shipment
Destination
� ~____ ......... ~~...................... .............................. ^~~_____~~'-^^~........................
_
El Disinterment --- Cemetery,
_ ..........._.............. ___���. ___-___' ----------------------------------.
� [l Roimonnor� Cemetery