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McCasland, Lawrence NEW YORK STATE DEPARTMENT OF HEALTH 4 117 Vital Records Section Burial - Transit Permit :;< Name First Middle Last I Sex Lawrence G, mcCos\c*Nel I �1 Date of Death I Age If Veteran of U.S- Armed Forces. o\ i 8'"LUII.D j 1 y j War or Dates i c15c1- 1 ci I9 5 Place of Death I Hospital, Institution or M City .ow?7or Village Qu. iy�bv�ry j Street Address 3% Hoef\ C.©U.()- „0 Manner of Death tAirT7 Natural Cause 0 Accident D Homicide 0 Suicide tri l Undetermined Pending tli Circumstances Investigation Iiii Medical Certifier Name Title Agee\ a • (;1\c+n; m i Address = \O - PG v\L S e e G-Ux\S'i a l\s , (J 1 1 Zg v ( - Death Certificate Filed Dis ct Number Reg��ter Number >` r Village akSLQYIS 'JC' I C I Date \ Cemetery or Crematory ❑Burial I CA \ \c\ ) 2b\ 9 Q'N,� V ,�e V3 vASLv(-YNCIa1 •:? �, l Address .':._= /A Cremation' QUSL\iA_ '_oO.d, Q QY Sbv�ry , N i ,-2goti Date ; Place Removed g E Removal I i and/or Held s• and/or I Address Hold I Date E Point of N Q Transportation.1 ; Shipment al by Common Destination - - • Carrier Disinterment I Date Cemetery Address i n Reinterment i Date Cemetery Address ... t '. Permit Issued to . I Registration Number -= Name of Funeral Home ,-�,., r-r`-- ,; l;t;Yi--- I oil 3o Address \-, ,-- ` Name of Funeral FVm Making Disposition or to Whom --J 1 it • :r Remains are Shipped. If Other than Above ` Address 44 Permission isI hereb granted to dispose of the human re ains described abgvT asd indicated. Date Issued ) 1�'( c�t(p Registrar of Vital Statistics O� C .9-a n-4- -,„ (SiMe) District Number629 ) Place / O v-7 L-,-Q- oc I ::: I certify that the remains of the decedent identified above were disposed in accordance ith this permit on: EDate of Disposition wI//if//l. Place of Disposition gl U+•.-s L iw►•gtter=h a (address) ii1 - fn CC (section) lot numbru# (grave number) • 0 Name of Sexton or Person-in Charg of Premises • i'ri �n Z (please print) Signature Title @ /VALL - (over) DOH-1555 (9/98)