Turpin, William It P 13
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name Fir t _ Mi dle Last Sex
Date of Death Age I Veteran of U.S. Armed Forces,
oZ —7 01-D!S 65 War or Dates AL,
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}.- Place of Death Hospital, Institution or
z City, Town or Village 1 nd i ah L�-K.__ Street Address ,,��
l Cc3-7 �Ct r 1�j YZ°r- Re/
Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined El Pending
ALI
Circumstances Investigation
ttt Medical Certifier Nam Titl
el Certifier
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Add! dL
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Death Certificate Filed VstLict Number Register Number
City, Town or VillageD53
[]Burial Date metery or Crem/ tory `/-
❑Entombment 2" .ff�e Vick) VZl'1'1G(7U�/
Address J
Cremation C(,Q.r✓r►s&'jj„i
Date lace moved
❑Removal • and/or Held
and/ldor
H Address
In o
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0 Date Point of
11 Transportation❑ p Shipment
G by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral HomeMi/l 7 ,i'-1�/ Nam- 0/ 1
Address l
4a5-2 AAls 4)1e 3D Mdla., L l2 fz -
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
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11. Permission is hereby granted to dispose of the human ins describe above as indicated.
Date Issued a) ) Registrar of Vital Statistics ; 0
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(signature)
District Number c905 3 Place �C f ,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition •z j 11 lit Place of Disposition CM 4.4 i Lj___
11.1
(address)
CO
CC (section) ii (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
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z ( lease print)
ill Signature 6 _/C-- Title fir,€tfieci1't.
(over)
DOH-1555 (02/2004)