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Gartner, Corinna ,13d0 NEW YORK STATE DEPARTMENT OF HEALTH • 1 Vital Records Section Burial - Transit Permit ><€ N e First � Middle i Last ex miii • itak 11::i Date of eat Age If Veteran of U.S. Armed Forces, 1 31 c ©!( 4-3 War or Dates• Place o Dea h Hospital, Institution or Cit Town r Village j,.n GI _da- -0- Str9tt Address5 p$a )cJ 3b 1 Manner of Death❑Natural Cause El Accident 0 Homicide 0 Suicide riUndetermined ICI Pending Circumstances 'Investigation 119 Medical Certifi Name, Tale Pa Addr Ss-x., 9_-/ I . /4_4) )t /a/9 D Death rtificate Filed District Number J Register Number iiiiiiii City,Tow r Village _CLA Z Z d S. Date C e-te^ry or remator�'1 ❑Burial 080b� Pci I ' C../�X. �Lu ) l Address Cremation �l.f',e bctA, , ) ,I /.),1 o 4 gDate ( Place emoved 0 Removal and/or Held and/or Address aHold Date Point of Q Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address ' Reinterment Date Cemetery Address is Permit Issued to n� Registration Number Name of Funeral Home / V� 0)1(_52_, 001 ct 9 Address W 35_7 ,s_fa-t 30 J'"Kfika_k k,Lkt_ )1-3 )0 4 Name of Funeral Firm Making Disposition osition or to Whom Li" Remains are Shipped, If Other than Above Address W i 'i< Permission is h re y granted to dispose of the huma re ains descri d above as indicated. iig Date Issued © )� Registrar of Vital Statistics id, L4 signature) „ District Number PlaceLW- Li 'sJi . I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f-W Date of Disposition if-7"11 Place of Disposition Pr' ��^^ Pm V'`c✓ C c 1{v' .o..- 2 (address) LU U3 , CC (section) lot number (grave number) G Name of Sexton or/fily . rson in Charg of Premises fi r r --h.Anti" g (please punt) t4 SignatureTitle CRG11 i t, . DOH-1555 (10/89) p. 1 of 2 VS-61