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Arcuri, Patricia 41— NEW YORK STATE DEPARTMENT OF HEALTH 511 Vital Records Section _ Burial - Transit Permit i., Name First Middle Last Sex Date of Death 1 Age If Veteran of U.S. Armed Forces, A?—©a// 1 7 77 War or Dates Place of Death Hospital, Institution or Ci , own r Village -,- H , s Street Address ' ;, 4 Mann Death El Natural Cause Illccident El Homicide 0 Suicide Undetermined "ending Circumstances Investigation Medical Certifier Name Title ��, ,.,g Address Death Certificate File 114strict Number 1 Register1 Number c�'�'City, Town or Village ( ) 1 ��--11 Date Cemetery or Cream tory `:: El Burial /.2 --Q-5.--/, 1-7 !/r e..--n" �.P 7✓ Address Cremation 67fii9,� Al., ,,/, &tie /.?iY _ Date Place Removed I'El Removal and/or Held _ and/or Address Hold Date Point of 2 Q Transportation _ _ j Shipment 5 by Common Destination Carrier 11: El Disinterment Date Cemetery Address Renterment Date Cemetery Address 11111111 Permit Issued to y� / 1 Registration Number <> Name of Funeral Home ; d'2 ,g, k.e.„y, l 0113 0 Address IC t4_,e_Je4.1.. 6_:i/ /VP /i2F0 V Name of Funeral Firm , king Disposition or to Whom r"" Remains are Shipped, If Other than Above Address IA Permission is hereby granted to dispose of the human rem ins described above as indicated. ili Date Issued) 01-{ <- /O ti Registrar of Vital Statistics C-�_ a e),, , _,,,_...„____ (signatu e Mii District Numbebo "Th Place ‘ b u---y-Th C- -c 0 ls;..Q.s1--r,. iii I certify that the remains of the decedent identified above were disposed 1of in accordanc with th permit on: LaLa Date of Disposition Mt L 1a( Place of Disposition '► I NV tea Con ur►w.. 2 (address) Ui (section) _ (lot numbet) (grave number) Name of Sexton or Person in Char e of Premisesit:i /.st`� t%,4c 2 (please print) Ltd Signature /8 Title Cat- mRb( - (over) DOH-1555 (9/98)