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Hunt, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH 111. � - ILVital Records Section BurialTransit Permit Kiii Name First Middle Last I Sex :::; El 2 o:o Q*v\ A • iAo n A-- i Date of Death I Age i If Veteran of U.S. Armed Forces, p1 131 ) -2-p1�Q ; \ LD War or Dates N )Pt JP -ce of Death ` Hospital, Institution or � Cit77 own or Village G-\,_02, s Ica\S I Street Address "h e_ P O A e S" -•;„, anner of Death ►r Natural Cause ❑Accident j Homicide + l Suicide n Undetermined n Pending Circumstances investigation Medical Certifier Name ff Title .01 t c {ry ©C c;,\OP M li __ Address �vk- Qiv\eS , UOOkrrer S -•1 &I.S2rS arc \\S, )1* -1 i?�p1 Death Certificate Filed District Number j Register Number da1+'�Town or Village - c r' S ��\\ i Date I Cemetery or Crematory ❑Burial ID� p\ aO\ `9 `- ,rcL ie.,� ��e�o. � j Address Cremation( ('t,�eNNSbk) c`i , .'`t. 1 • <LT t- Date Place Removed 0 ❑Removal ! I and/or 9eid and/or : Address ��___ _-- — Hold I - -- 0f ! Date P::ini;+f NE Transportation i __ i Shipment a by Common Destination Carrier Date i Cemetery Address t Disinterment Date Cemetery Address [ j Renterment 1 K.i Permit Issued to 1 Horne__ Registration Number Name of Funeral Home 6Cc t:T hr_L,ie a-/ / i rnZ l , , Address •1i l CiTC--L(C l d • , C LULLnS -i.t t_1 , Aje_ cJ L1L44- 1 J eol Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. :-!.:1::i! Date Issued 2 l i lib Registrar of Vital Statistics [J -e- �I), _ v\_ (signature) r District Number 560 ) Place G � c �\S I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F Date of Disposition ""14 Place of Disposition P;he,d;e ry C"reffv aio c,y m (address) ttl X (section) (lot number) (grave number) GName of Sexton or Person in Charge of Premises TLrrw.> .&gu1Le,s Z t / (please print) Uel Signature �,�,- „., Title Cr.t ' +ci r 1� (over) DOH-1555 (9/98)