Stanco, Anthony NEW YORK STATE DEPARTMENT OF HEALTH s 3 Z
Vital Records Section IP o- Burial - Transit Permit
41 Name Firsttit� Y' Piddle U ( hp Last Si W Sex ' r l
iky
4 Date of Death , i ii
Age If Veteran of U.S.Armed Forces,
o . - or Dates
.< PI a of Death He-•'r)Institution or �/ /--/
Town or Village �7 WIC F4Ic - . Address l s / C /S
ner of Death Natural Cause ❑Accident 0 Homicide El Suicide 0 Undetermined Pending
Circumstances Investigation
x% Medical Certifier Name Title ilo V-0.gei't . Lo 1) -e- (.1)
` Address
I (v Iti-r3a. e, Cal bi C jeA S t1 c, j�I 1284 I
Death Certificate Filed District Number ..co I Regis um
1 Town or Village qq,,,,5 A-0,16
Date Cemetery o> ato "l��
ol3urial �� 1I !jriK 1li -rami
Address
11 k remation Uj\ i ini 1(,i CNkird/yl,S bi\I t N \) 12VG if
Date Awe Removed
0❑Removal a and/or Held
l and/or Address
a Hold
9. Date Purnt of
jQ Transportation i Shipment
3 by Common Destination
Carrier
:: ID Disinterment Date Cemetery Address
[]Reinterment Date Cemetery Address
Permit Issued to f Registration Number
Name of Funeral Home/�c1nard b. Za.Rer Fw,ecad Home 0[130
.' Address
// La a.y to of. , b u.e.ens xury,)U LJoc)c. l a eoy
; _ Name of Funeral Firm Making Disposition or to Whom
,." Remains are Shipped, If Other than Above
Address
Allah
Permission is he y granted to dispose of the huma remains described ve as. di— - •.
r. Date Issued �� •1 i eD/• Registrar of Vital S i tics
. J (sig re)
District Number J-6Oa / Place TO-I14 /
I certify that the remains of the decedent identified above were disposed of in.accordanc with this permit on:
E Date of Disposition 711310 Place of Disposition at I C f 6:...
faL! (address)
MI
CC (section) (lo number) (grave number)
QName of Sexton or Person in Charge of Premises 11v jvPL,,. _5iA.tlt
Z �/4 (please print)
Signature G� ,y Title elztwilL
(over)
DOH-1555 (9/98)