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Foster, Dolores NEW YORK STATE DEPARTMENT OF HEALT!`i 1 Vital Records Section Burial - Transit Permit Name First Middle t Sex. IJpzo12.ITS L O 21 .Etii� JOS �YL F�I/,'Zd- N Date of Death Age If Veteran of U.S.Armed Forces, 17 I 7 War or Dates "..)/4 za P - - of Death �^ ospita! titution or • '"� own or Village Llr, I—�3''L L S eet Address c .� s Fe-a,S annex of Death um Natural Cause 0 Accident El Homicide Suicide ❑Undetermined Pending Circumstances Investigation Medical Certifier Name Title �1 -& a to MK} k 1 I6 ) /=/� / l 6 Address Q /CZ, PO-n.4 C._ '5-.- .: •-._ .• -rtificate Filed District Number 5 1 5t ester Number 'ffs; C' , a or Village (�, t,cS',•)S feu.,C �� .2. i 3 r—t Date f I Cemetery�r Creme • A:"`:I.�iBurial `///O/ /7 /�1 tsr &-.1.° :.:.: Address (✓ OCremation Q U c %.-)s e, u Date Place Re ved fl❑Removal and/or He and/or Address g Hold 2 Date Point of .iA D Transportation Shipment a by Common Destination Carrier :: Li Disinterment Date Cemetery Address -. Q Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home ! CZfd v &er Funeralm� Of 3Cj : ; Address Il Lax 7 a-t-/d* cY. , b u-eens+buf 4 t Aka) Vvrk- l a eO`i Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address .s. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued Li ( ( 0 f 17 Registrar of Vital Statistics vv ��l/ }(signature) x,. 1 C(1 Place t ( .)"-S F\ 15 , kV ��� District Number � � I certify that the remains of the decedent identified above were disposed of in.accordance with this permit on: 1^ Date of Disposition Place of Disposition 2 (address) 111 cc (section) (lot number) (grave number) ° Name of Sexton or Person in Charge of Premises Z (please print) Signature Title (over) DOH-1555 (9/98) Apr 11 17 09:12a BAKERS FUNERAL HO € , - 1 518 7610044 p.1 NEW YORK STATE DEPARTMENT OF HEALTH 17 253 Vital Records Section Burial - Transit Permit 04 Name FirstL, Middle t Sex . oLo2& S © r_ 1 ..)A)i J_'os i&7z�,Ee. F�9ig-Ztr Date of Death I 1 Age I If Veteran of U.S. Armed Ford /7 !7 �` Br Dates !/ ' ro r- of Death _ r �-~ ospital -t =.oFr , City Town or Village y LFS�c !-1"L L S ;eetAddmss C c- 1 s Fi.9 .S i,P. anner of Death 09 Natural Cause D Accidertt E Homicide El Suicide DUndetermined n Pending Circumstances Investigation LT Medical Certifier Name a Title A , / t.-> r6 iy 3} - kl}I L ) /=/-- / ,1) Address C 19-Zt.J L • -rtificate Filed District Number 0 , ' ^ f gister Number t'. � � 1=� City, own or Village ��cS•J S E1�C 2 13 Date I I Cemetery(r Cremat�:::: ❑:Burial 41//v 2 r(�c A 8� ((��� Address t.L.1'cremation V/117-,;,?S e., u7Z(/ / Date /Place Re ved a D Removal and/or He and/or Address i' Hold 0 Date Point of wLiTransportation _ Shipment by Common Destination Carrier El Disinterment Date Cemetery Address El Reinterment Date Cemetery Address ; ., Permit Issued to 1 M� Registration Number fr Name of Funeral Home I cynard b. oaker Funeral 01I 30 Address Il LQ o'1 ,- (51-, ,&t. .e.ens, ,1Uerw L/0rk Iaii701 N• ame of Funeral Firm Making Disposition or to Whom Remains are Shipped.tf Other than Above Address Fn DI Permission is hereby granted to dispose of the human remains described above'as indicated.f D• ate Issued L1 1 10 1/7 Registrar of Vital Statistics (A3 E�JIr y.j• U" )��i `4ic ,z� (signature) ":` District Number 5 60 i Place l(C h -S Fes' ,S / N V > I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: D• ate of DispositionPlace s pos gilt��1 of Disposition ant ►tom lrfyi^4"t)f',ny..,, M (address) ILI 14 (section) (ipt tuber) (grave number) Name of Sexton or Person in Charge of Pre 'ses (1 is .�4*Att (please print) 19 Signature .- Title 14#3411kt (over) DOH-1555 (9/98)