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Perry, Joseph NEW YORK STATE DEPARTMENT OF HEALTH .c , . '% I '� Vital Records Section Burial - Transit Permit Name First ---- ____Middle Last Sex j os` 1h'�u,' r !�(Date of Death Age If Veteran of U.fle-r Arm Forces, ' 1--5 7 o r-7 War or Dates :)., Place Bath Hospital, Institution or City Town or Village l`;n- Street Address ' '-t. G t ('j C 4 Mari f Death Natural Cause El Accident Homicide Suicide n Pending CircuUndeterminedmstances Investigation CA Medical Certifier Name Title 5,,.s.c, 1-1 —Nt 'a,- �o r„t tom` Addres 5 `� GrK-� Ave-- S«cam S N� /�,��6 Death ificate Filed District Number O �` Register Number 1 City. -''r Village Cry is, W( `±5 S2) 1 Date Cemetery or Crematory f nBurial I . /-15� 'ao/ /' / s✓1�View t�l,L-4,ef Cremation Address if)til C.0 v\e S._6-'t "J `( Date t Place -Removed Z Removal O — VI and/or Held and/or Address H Hold O Date Point of 0 —Transportation Shipment n by Common Destination Carrier E Disinterment Date Cemetery Address. . Reinterment Date Cemetery Address Permit Issued to - — Registration Number Name of Funeral Home "fnA.2F� tH ,1,.,L— ©oL-� Address 7 0, etvh.g-rk �• -( l Name of Funeral Firm Making Disposition or to Whom F" Remains are Shipped. If Other than Above : Address ': Permission is hereby granted to dispose of the human r ains scribed ov s• icated. Date Issued //10/17 Registrar of Vital Statistics ,(A4 / ca re) _ District Number /—C O Place rr /�)�;.J /d rit I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition 4/n/f Place of Disposition �gelJut', Zomirkasfo-- W ... .. (address) I CC (section) (lot number) (grave number) a• Name of Sexton or Person in Charge Premises lir,1+is Sind Z (please print) illSignature Li Title (RE MN_ I DOH-1555 (10/89) p. 1 of 2 VS•61