McGrath, Richard It 51
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ,f Burial - Transit Permit
Name First Middle Last Sex
Date of Death Age If Veteran of U.S. Armed Forces,
01 �./.g,/ e.„ War or Dates c I c1'//a
Al Place bf Dea Hospital, Institutio or _
y ( g� ,/ ,4I.94� .� . ,/ /9vz
:Z City, r Villa e � Street Address S'�G'O �
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
/?? /? Y CRe7gSm/ ,V /71, 12 ,
Address
, -057o�_ A"7 A/ y g TJ Ca /7- ,9, L dVy��<P��
: Death Certificate Filed District Number Register Number• .City, or Village ~ 576 4 02/
Date d� Cemetery or Crematory
❑Burial `/e/Q//o�.'// Cs2/A/4//z?-f;eA9. i9TO e/(i/Y1
Addres
::::Cremation Qt/ sr age.,i, i )/ ,/ ac4
Date Place Removed
8 Ti Removal and/or Held
••• and/or Address
Hold
Date • Point of
0 Transportation Shipment
fl by Common Destination
Carrier
:::: Disinterment Date- Cemetery Address
Reinterment Date Cemetery Address
III Permit Issued to Registration/Number
iiiiiiiiii Name of Funeral Home/2 iv,/ P'4'A/L//9_ 22 ? c �//
RI Address
PO lR / __&/• /ag2 c 1
> < Name of Funeral Firm Making ClOisposition or to Whom
"" Remains are Shipped, If Other than Above
: Address
ail
Permission is hereby granted to dispose of the human remains describe ove as indicated.
: Date Issued /f/ // Registrar of Vital Statistics� G c_..
(signature)
��/v District Number
Place ,J?KC,_ 1/7.(47-4"- ---4,-.6E-e-e--
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f- -
WDate of Disposition 11 I I lii Place of Disposition -RN Utty+ Cr ciofiu"-
2 (address)
fJJ
CC (section) r ~ (lot numb (grave number)
GName of Sexton or Person in Char e of Premises (h+tstpr SC t
A (please print)
W Signature Title CIZeM106-0t2.
(over)
DOH-1555 (9/98)