Saunders, Raymond 4tig3
.NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ' ` Burial - Transit Permit
Name First f\ Middl Last1 Sex
Se)vt1
Date of Deaty\. V Age If Veteran of U.S. Armed Forces,
AAc_ DA, ' o17 3 War or Dates
� Place of Death.. Hospital, Institution or
Z City. Town '-laga �-/�'r•"k-'k. Street Address
cManner of Death 7 Natural Cause 0 Accident 0 Homicide Suicide �Undetermined '— Pending
� Circumstances —Investigation
W Medical Certifier Name S Title
Address // .�
I6I C&re-A Q.�ccAs . .,,r , M T 1 0
Death C icate Filed /' V District-Number- Register Number
City, own or 'liege C. '`t.
_ Date / Cemetery or Crem�ry /'
_ Burial (Dfo11.��of7 f , e• .-a,... 6;0.i1,--)y
Address L-
1.� Cremation a 1/4.k«^s I, ,,r 1 , Pe., /,rpU.
Date Place Removed
Z — Removal and/or Held
O and/or Address
Hold .
O Date ' Point of
55 Q Transportation Shipment
a by Common Destination
Carrier
—Disinterment Date Cemetery Address.
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home( 1,i.c ,PC ""^e.�` l N3+t— d°`//r
Address
7 .....C4 er.......,_ Av
Name of Funeral Firm Making Disposition or to Whom /
F' Remains are Shipped, If Other than Above
Address
•
Q' • :scribed ov s' icated.
Permission is her
by granted to dispose of the human r=
iiii Date Issued ‘ /a4./7 Registrar of Vital Statistics I It - Xiyt/
•'a Are)
S ,
District Number `� S Place ��'�• � �L"r
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 61ze 1`7Place of Disposition Ed
(address)
LL1
C (section) (I number) (grave number)
Q.Name of Sexton or Person in Charge of Pre ices LAP- -limin
(please print)
W Signature ✓ Title Cat 190-1)44_
D01-1-1555 (10/89) p..I of 2 vs.61