Curran, Marion t
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex r
h'10.r� �n E 1i-„ab-e+h Curran
in Date of Death , 1 11 t b Age 3 1 If Veteran of U.S. Armed Forces,
War or Dates
g....�•` Place of Death CC Hospital, Institution or Foci- 4tAti ton Ni�(Ci 914orAnt
<2>Cityr Village Fort. E d004 Street Address 31di PSfocdwo j For 4 EcL Ja,rc! 14.V.
Manner of Death Si Natural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Address
Q C f res..a.1' Q,....a a v,Fs f , n) �( tom'
<: Death Certificate Filed ' District Number Register Number
<; City, i Vo r
r Village #- 5165 , 33
Date Cem tery or Crematory
Burial O` TkOl CD In
e vie CeMbtutf
- - Address
❑Cremation
QU er `Boca coke-ens.61 N tAA, `01. 17-ro LC
Date _ 1 Place Removed
. 0❑Removal I and/or Held
1.-2 and/or Address
vii Hold ,
0 Date Point of
0 Transportation, Shipment
ES by Common Destination ,
Carrier
Disinterment Date I Cemetery Address
Reinterment Date Cemetery Address
gi Permit Issued to _ _ d Registration Number
a!I Name of Funeral Home _ Rt}X -yt_ fri;..-4.7.--r4-., /A Di)SQ
'3 Address
If �jE7rn,--..- c i, 0 ua.: ")s r i>t'' Ay (2 II
4 Name of Funeral Fjt'm Making Disposition or to Whom I - •
Remains are Shipped, If Other than Above
04 Address
Jai
1
-- J`;: Permission is hereby granted to dispose of the hu n r s descri ed a ve-a indicated.
Date Issued ']-1 1(0 Registrar of Vital Statistics r 1
iiiii _ (sign t e)
Iiiii District Number8165 Place /6 dux0-6t (C(Ad
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 7/1 5/1 6 Place of Disposition Pine View Cemetery, Queensbury, NY
2 (address)
w Mohican ' 85A 2
C (section) (lot number) (grave number) •
0 Name of Sexto-f r Person-in Charge of Premises Connie It. Goedert
Z (please print)
f:L Signature i z / Title Cemetery Superintendent
- (over)
DOH-1555 (9/98)