Delaney, Catherine NSW Yf'K'2K STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Catherine H. Delaney Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 6, 2013 93 War or Dates 1943- 1946
t.. Place of Death Hospital, Institution or
Z, City, Town or Village Village of Tarrytown Street Address 40 Miller Avenue
DU
Manner of Death X Natural Cause 1 'Accident 1 I Homicide 1. Suicide Undetermined Pending
wt
Circumstances Investigation
O. Medical Certifier Name Title
n Charles Abate M.D.
Address
310 North Highland Avenue,Ossining,NY 10562
Death Certificate Filed District Number Register Number
City, Town or Village Tarrytown 5911 19
0 Burial Date Cemetery or Crematory
❑Entombment May 10,2013 Pine View Cemetery
Address
❑Cremation Queensbury, New York
Date Place Removed
Z I I Removal and/or Held
O and/or Address
N Hold
in
O Date Point of
1351 _I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Beecher Flooks Funeral Home, Inc. 00160
Address
418 Bedford Road,Pleasantville,NY 10570
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
♦B.'
Permission is hereby granted to dispose of the human remai d scribed abo a as indicated.
g (7a7 `�`4
Date issued5/9/13 Registrar of Vital Statistics �
(signature)
District Number 5911 Place Tarrytown, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LLJ Date of Disposition 5/1 0/1 3 Place of Disposition Pine View Cemetery
(address)
cn Sec. 24 Ondawa 162 16
Q0 (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Connie L. Goedert
Z (please print)
W Signature Title Superintendent
(over)
DOH-1555 (02/2004)