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Major, Crystal NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial-Tra• sit Permit tat Full Name: CRYSTAL DAWN MAJOR ❑ M ❑X F `'` Date of Death: 01/22/16 Age: 31 If Veteran of US Armed Forces,War or Dates: City,Town or Village of Death: ROCHESTER Hospital,Institution or Address: 160 MANOR PARKWAY,APT.3 irK Manner of Death(Check One): ❑ Natural Cause © Accident ❑ Suicide Homicide ❑ Fetal Termination El Pending Investigation 64 Kg Medical Certifier Name,Title: NADIA A.GRANGER,MD KW P.,,,w Address: 740 E.HENRIETTA ROAD,ROCHESTER,NY 14623 ktt towt Death Certificate Filed in: County of Monroe District 2700 ❑ Burial Date:02/01/16 Cemetery/Crematory:PINE VIEW CREMATORIUM wttwtt Cremation 111 © Entombment Address(City&State of Cemetery): QUEENSBURY,NY tt.tt❑ Hold Date: Place for Hold: zws- ❑ Transport Date: Point of Shipment: "elti ` p QeQ VP' �As rtlt Point of Destination: Cie CRo.t! e ttst 0,6 ❑ Disinterment VOC\e" % Date: Cemetery: ® �j JP dot ❑ Reinterment II IV Date: Cemetery: OC:C\4-�Eatowt 'V' itttt Permit Issued To: BARTON-MCDERMOTT FH Registration No: 141 eft Address: 9 PINE STREET,CHESTERTOWN,NY 12817 witt taw Name of Funeral Firm making disposition or where shipped if other than above: Address: ttg!t Permission is hereby granted to dispose of the human remains described above as indicated. 0:Issued Date: 1/26/16 Deputy Registrar of Vital Statistics / Frank Golisano 744,dc A, (..„:„,...... ., -:,,,, District Number:2700 Issued at: Monroe County Department of Public Health-Office of Vital Statistics Sub-Registrar Initials: ,_.....AA I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition: 11/i fJ 16 Place of Disposition: pi fivii, e,1,,) Gt'tyw f6r KN krzki Section: 1 Lot Number: 1 Grave Number: iitli 4 Name of Sexton or Person in Charge of Premises: J< r l"`` Y S NSir L S roi Signature: �s� Title: CIt�,G1oc' Witt