Bowman, Edith NEV YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex_.,
1.51rr - (j L-IUia- LSo t.J-,/,9,J 1-40
Date of Death Age If Veteran of U.S. Armed Fgrces,
e` `d f/ e-? , - `' e tes �f -
H e of Death Hospita, •• titution or ��us
iU �`,.City, own or Village 6, )f F,�1� reet Address �G�.-33
aW anner of Death Natural Cause Accident Homicide Suicide Undetermined 0 Pending
_ Circumstances Investigation
la Medical Certifier Name Title A ,�
0 _ Gv c It6)
Address
i Ap 0 t v.3 Q -vim:-. a /t/
II-- Certificate Filed ' District Number j R6egistfrr Nu er
City •wn or Village �( ,..)� F,�'?�.f , ,`j 6(.�'/ 1 T7.,o2
1,5 :urial Date / 'Ii -�k r Cr atory
ell /3 //_/ l I - cr �r
l
LA---
0 Entombment Address } ,(
['Cremation1 �C /�j �'g v
7' . /
Date Place Removed
Z Removal and/or Held
aL—I and/or Address
N Hold
0 I Date Point of
NQ Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date I Cemetery Address
Reinterment Date Cemetery Address
l
Permit Issued to Registration Number
Name of Funeral Home MGM/nCU LA -b, maker 1Xr C1 Jr-()r 1 0 1130
Address
a-Cay c .e `)A . , (.;2 k_l,c C S ,r`/ , tie ,,._., . 0 r- k_ 12 si U,--`Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
13:
W
A. Permission is hereb granted to dispose of the human r ains described abo as indicated
Date Issued ZO/ Registrar of Vital Statistics _
(signature)
District Number a/ Place 440/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2 8/13/11 Pine View Cemetery
tti Date of Disposition Place of Disposition
12 (address)
Oneida 176 1
ta
(section) (lot number) (grave number)
0 Michael Genier
p Name of Sexton or Pers n in Charge of Premises
_ (please print)
itt Signature Title Superintendent
(over)
DOH-1555 (02/2004)