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McCasland, Blanche it ' NEW YORK STATE DEPARTMENT OF HEALTH I 4 2 Vital Records Section Burial - Transit Permit Name First _ Middle r Last Sex .4?>LA2lc//4 / 1 L Cittsaiv? EH4� Date of Death Age If Veteran of U. Armed Forces, T)k1t -2‘ n// /L?5- War or Dates ;v/,9 i- Place of Death j , p/ CL,€g Hospital, Institution or Aiyc -(Ariz-Sin/ ME/2C y CENr62 W City(Towr�or Village Street Address/t.-S pL) M/l.r-i92y /ZD.. W Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined El Pending Circumstances Investigation ui Medical Certifier Name Title D .DC86RAt1 Higi ak044 AI to Address /Ss oco 1-r.Lt pgszy Ai) axe e PL•440 N / Z V. Death Certificate Filed District glum er Register Number City�^wr r Village NO,Z�y gziza 5:g0 ['Burial Date Cemetery or Crematory 6 - -2 7- ,.0i1/ ',A/ ' V/6u 02-6H,47-o/Z/ ❑Entombment Address EiCremation -- / ('c>A/J.g.a. 2D Qcie6v.C8L>>ty , N y /.a'eV Date Place Removed Z❑Removal and/or Held 2 and/or Address H Hold Cl) 0 Date Point of CI. ❑Transportation Shipment 0 by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home//61 _ elArz. < j / , (3/(j 9y Address -?3//a .4/ZA,vr9c At LARkf A4C/4 ni y / Z Y' .. Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above 2 Address CC IW Il Permission is hereby granted to dispose of the human remains described above as indicated. ' Date Issued X-. 7 2 i// Registrar of Vital Statisticsj“.:4AiK',,,, r [/v�-� � C rt (signatufe) District Number/ &) Place TUG,vA) ©, A/02r// ,�Ct,4 I I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I� Date of Disposition �r-t^`si'�ti1 Place of Disposition l,v �ti� �t'+4P4i00— (address) WI CC (section) (lot num (grave number) Name of Sexton or Per n in Charge f Premises 4 number (grave llease antnat print) 7L.LU Signature Title ce M (over) DOH-1555 (02/2004)