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Schramm, Edward G. . NEW YORKSTATE DEPARTMENT OF HEALTH BUrl 3bal - Transit Perml Bureau of Vital Records Name First Middle Last Sex Edward G.Schramm Male Date of Death Age If Veteran of U.S.Armed Forces, 04/10/2020 94 Years War or Dates 1942-1946 f.. Place of Death Hospital,Institution or Z City,Town or Village Freeport Village Street Address Meadowbrook Care Center, Inc p Manner of Death © Natural Cause Accident 1:1Homicide Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title Neil Jaglall MD Address 320 W Merrick Rd,Freeport Village,New York 11520 Death Certificate Filed District Number Register Number City,Town or Village Freeport 2904 81 ❑Burial Date Cemetery,Crematory or Facility Name 04/17/2020 Pine View Cemetery&Crematorium Entombment Address - nCremation Queensbury Hamlet,New York ❑Donation 'Z Removal Date Place Removed P and/or and/or Held F asHold Address a. Date Point of U) ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home N F Walker Inc 01234 Address 2039 Merrick Avenue,Merrick Hamlet, New York 11566 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/14/2020 Registrar of Vital Statistics McCind'a TGee(ECectronicaCCy Signed (signature) District Number 2904 Place Freeport, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1— Z Date of Disposition Place of Disposition t!J address/ W N (section/ (tot number) (grave number) IM I AA 0 Name of Sexton or Person in ge of Premises F 6/p ease print/Z W Signature `1/ Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1, 3 yd Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#