Loading...
Akins, Hubert NEW YORK STATE DEPARTMENT OF HEALTI-- 4. 14 r`lC Vital Records Section Burial - Transit Permit Name Jirst • Mir le Las Sex Date of Death_ Age If Veteran of U.S. Armed Forces, �- � ' / / � War or Dates 1475= 'S6 Place of Death Hospital, Institutiosyorui Q, City, Town o f i{la.., 6 r V (t-e Street Address_1 2i4 / !��i& 46/1t(Q 1' 0 Manner of Deat « Natural Cause 0 Accident El Homicide Ei Suicide Undetermined El Pending t Circumstances Investigation iti Medical Certifier i Nam itle \J n(k -/- dyes r Address All, f ?es 2___ Death Certificate Filed District Number Register Dumber City, Town or - age 6 ran vi ffe 57d 0 ❑Burial Da e prriet9ry or Crematory Entombment /` if/le & 1eW Cre r;an? Address ;_;;;:Cremation quQ?PLC tt.4- 7 Date Place Removed ❑Removal and/or Held and/or Address Hold 0 Date Point of ti 0 Transportation Shipment ES by Common Destination Carrier :: Q Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to //^^�� Registration Number Name of Funeral Home At.,s')t truth) / - Q///7 .> Address 1 it' 67� e ,SY / #44, to // ��7 gil Name of Funer I Firm Making Disposition or to Who fn Remains are Shipped, If Other than Above Address 0 ;: Permission is hereby granted to dispose of the human remains enssccrriibe boy indicated. ©� ��� Registrar of Vital Statistics Date Issued / /l g signature) District Number Place 6 rtim0t jt I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Place of Disposition ,•�u ' n^ `i ti r a tor, Date of Disposition `1�t�+ (address) (section) . (lot number) (grave number) !e nt>1 }�... 1 Name of Sexton or Person Charge of'remises (phase punt) lk Title C¢ Signature i' (over) DOH-1555 (02/2004)