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Flanagan, Mary NEW YORK STATE DEPARTMENT OF HEALTH I --` Ltfg Vital Records Section Burial - Transit Permit Name First Middle Last Sex Ma, Fla.ncc .oz 1 __ Date of Death Age If Veteran of U.S. Armed Forces, I.a ) S ) $ Co S War or Dates It, Place of Death Hospital, Institute or City, I own .r Village /4 J Street Address L() 13rd Manner of Death LW Natural Cause Accident ❑Homicide 0 Suicide ❑Undetermined11- Pending Circumstances Investigation • Medical Certifier Name Title Address FALh 0- Au 6 (b(1L11/ 1.14 Pl. 11t1L Death Certificate Filed District Number Register Number City, ow or Village ; L 3gR Date J eneter or Crematory • ❑BUr1aI 6 / 1 g 1 / 2 T 1eVLex6 Cr❑Entombment Address Cremation L ©b n (\ ' .:,,.. Date Place Removed ❑• Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment -- by Common Destination Carrier Disinterment Date Cemetery Address 74-4 LiReinterment Date Cemetery Address 42. Permit Issued to Registration Number Name of Funeral Home _ A r ,IL i WUl $ A .a►. Address t- Luz.a 1 zg41b Name of Funerdi Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as at • Date Issued Co 11 lS Registrar of Vital Statistics jJ (signature) • District Number L 51i Place ) 1 ail Ltd 1\1 • I certifythat the remains of the decedent identified above were disposed of in accordance with this permit on: r " ' Date of Disposition t Itt I 1S Place of Disposition P..V,..i rift_ (address) (section) (lot n mber) (grave number) Name of Sexton or Person in Charge of Premises (, 11...E /� �^ (please print) • Signature i✓` ' "'c Title /iItReL (over) DOH-1555 (02/2004)