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Saunders, Betty
`,E ,v a NEW YORK STATE DEPARTMENT OF HEALTH - till Vital Records SectionBurial - Transit Permit Name FirstMiddle Last qq Six _ 6H, vt,-tncJAe-�'g� -j-e�..L� ,,_, lii Date of Death Age If Veteran of U.S.Armed Forces, . <r /61 't/i 20 War or Dates .">. Plac- - '--th Hospital. Institution or . ': C , Town or illage �5..„s Street Address A -ctA-t _ jv . H --,„ Man-aaso1eath Q Natural Cause El A dent Ei Homicide Q Suicide nUndetermined r 1 Pending Circumstances Investigation ": Medical Certifier Name - Title Addres v ��n-or- 6_12_ u�-e--As, ,..At N i caV O tt- Death 'icate Filed District Number I R ester Number lig City Ton o illage ( G t 1 •I,,.f 5-6-S 7 Date Cemetery or Crematory Burial R/ 6 is oil t44.0.24l;�.L...3 MK- + • Address �� (:::: Cremation �. CA,5 0 N C w j e t+��-. Date Place Removed Removal •' and/or Held and/or Address Hold Q Date Point of 5 0 Transportation Shipment fa by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address inii Permit Issued to ( ,--"' Registration Number Name of Funeral Home J 5,N,{c �";�n�.ti( }—},M{/ �-,� ©D f-i( Address /7 1 L 1( -1 Lir Name of Funeral Firm Making Disposition or to Whdm r Remains are Shipped, If Other than Above Address • w; Permission is hereby granted to dispose of the human e ains described abor as indicated. ig ig Date Issued 9/&/11 Registrar of Vital Statistics q . a _�� IN --y (signature) Iis (' CD �. �'. District Number�j 5-7 PlaceC' k,,,., 0 • r : I certify that the remains ofrthe decedent identified ai3ove were disposed of in accordan� wit this permit on: 5 Date of Disposition q Ii(II Place of Disposition �,K(uv ettroAtKia.., (address) U C (section) (lot number) (grave number) Name of Sexton or Person in Charge f Premises <<)1 r Aal4' (please print) U Signature / _ Title GTE AR-TOR (over) OH-1555 (9/98)