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Vinskus, Vincent NEW YORK STATE DEPARTMENT OF HEALTH S lJ Vital Records Section ' • Is Burial - Transit Permit Name F����`'/ — Middle ��Sas 5��� Da a ofLeath Age If Veteran of U.S. Armed Forc , 0,2 9 ap� �� War or Dates P - e oafh Hospital, Institution or 5 e , Town or Village ,7� Street Address Manner of Death 0 Natural Cause 0 Accident 0 Homicide D Suicide ElUndetermined ri Pending 0Circumstances Investigation ul Medical Certifier Name Title 0 �je%// 'i U" �cc . A'ddre ZG-7- ff0(k- d'i- . ),,o--,v,r- /"" Z ,. MCertificate Filed District Number Regi umber own or Village �4fiy)'c r42/ \3 d f 1 ❑Burial Dat ,Ge eter�y or Crematory �� DEntombment `i /o�©/ ��'1�-e -e (G"� %�lsvj Addre / J remation ( ,'_e/i�r Cf�/ �/7d / d 7 Date Place Removed ❑Removal and/or Held and/or F; Address Hold ta 0 Date Point of 05 Q Transportation Shipment 0 by Common Destination Carrier Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to _---, _, Registr ion Number Name of Funeral Hor cr�G/v77—//c,�/✓2e��j671Pic /a7 Ac,_ 3e9 Address �/2 s'% Ckcam 4,, - J, X /�(/ Name of Funeral,Firm MakingDisposition or to Whom p Remains are Shipped, If Other than Above ,'; Address IX UI "` Permission is hereb gr ted to dispose of the human remains described above as i i ted. Date Issued / , Registrar of Vital Statistics I-We-c `L /1 /� (i nature) �a District Number 6./ Place C ! - © „/ /� f,A.�� / '✓ `,, I (LY�'L lG'� I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILL Date of Disposition i1(�(�, Place of Disposition 'r,to„..... ,r (address) 111 VI CC (section) (lot numb r) (grave number) Name of Sexton or Person in Charge of Premises abilie c,- 2 (please print) Signature a Title Obi tit ftt • (over) DOH-1555 (02/2004)