Ovitt Sr., Thurland NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name irst Middle ast Sex
lIA,r ICt.it(4 OVli _Last
/11C IP_
Date of Death Age If Veteran of U.S. Armed Forces,
I `(73 7 20/ 7 7(V War or Dates /qc,o
j- Place of Death �I Hospital, Institution or
Z City, ow r Village CO r I (1 T Street Address 51- €,t .r'L m �Gi ,
a Manner of Death Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending
ill Circumstances Investigation
W Medical Certifier Name -,,• (1 Title
1, 1 I .y At': .; C+: `/�.Y-1.d ' i ti'\ L
dress
Cbrn-th /V
Death Certificate Filed / District Num ef. . ..,. Register Number
City,(`fown'p �r Village .0r--a r `/ { ._ .`.
❑Burial Date �1 etery or remato
❑Entombment A dr
r
aei 1 7 I ne i s uu) ,?Tina nJ
Cremation (t fJ ni VDate e Removed
is �Removal and/or Held
and/or
N Address
fa
Hold
Date Point of
tch❑Transportation Shipment
G by Common Destination
Carrier
El Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to ll Registration Number
Name of Funeral Home-L , - 47_,LI 2,& 117 7YYl? IIJ G OO I
Address
( 1- C'hurCh St look Lti .; MI /2g*,
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
2 Address
I
LEE
it
Permission ishQreby/granted to dispose of the hum emain descp,ed a v indicated.
,
Date Issued (f 342// ? Registrar of Vital Statist cs �LI
//( (signature)
District Number Y'27 _3 Place ,
c' 4
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
E.
ui Date of Disposition 211 ( ii Place of Disposition PipkkoMr (trmQ0`rih
2 (address)
ill
CC (section) k(lot number) (� (grave number)
Name of Sexton or Person in Charge f Premises 1tfl itAiZ it
2► a (ple a print) A
Ili Signature f Title ( ���1Jd
(over)
DOH-1555 (02/2004)