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Torregrossa, Louis E A # 70(, NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex 10 U 1 S To r r-e Gro3.s o. I4it of -e_ Date of Depth Age If Veteran of U.S. Armed F es, ( 3 /to J 2O/ , �3 War or Dates Place ath Hospital, Institution or City, w r Village a k A ee zs b Street Address Manner of Death© � Undetermined Pending Cause Accide Homicide Suicide Circumstances Investigation 1}i Medical Certifier Name Title i ,S t L2a.n n.e `U oaA ✓►1 t� Address I Death Certificate Filed ictrr�b�r aster Number City, own r Village �j ,(,(eec S644./- �� )i Co ❑Burial Date J metery or Cremato ❑Entombment O 3//7-/ 2 $0 6 //)� View c rt mom..r`0Ly Address �` �� p /� / gCremation 2/ OC.t a.acsc x_o. Qt,cee siapq! y /ZSoV Date Place Removed / / Removal and/or Held and/or Address Hold Date Point of .4. EITransportation Shipment • by Common Destination O Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Ki i'nor /-fo Registration Number Nameof Funeral Home6 u h e/'a- rye-_ o/o ? Address l .19 m a:40 - cSo, G lens -ra//s', iY /z 3 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address 1 a" Permission is,hereby granted to dispose of the human reins desc ' ed a v s indicated. Date Issued 1 1 I I Registrar of Vital Statistics I )c. r (gyp___, (signature) District Number ocrl Place 1 O N cc -.0. I certify that the remains of the decedent identified above were disposed of in a ordanc with this permit on: Date of Disposition 3I1$//1. Place of Disposition ei it./ aa�� (address) Lli (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pre ises f�+�s �m✓/6- �A (ple se print) Signature �✓` Title Aarottgit (over) DOH-1555 (02/2004)