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Sarro, June
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name Firs Middle Last Sex NI � \e 5crr © Fe c,e Date of Death Ag fj e/ If Veteran of U.S.Armed Forces, / / / / — / (�— /.5 q War or Dates /� I- Place of Death Hospital, Institution Z City,Town or Village City of Albany or Street Address WW Manner of Death /gyp( Natural Undetermined Pending v"" Cause ❑ Accident ❑ Homicide ❑ Suicide El Circumstances ❑ Investigation Medical Certifier Name n^ Title ( � O '�c r G k ci✓ 1 Iiar�;Ke I I; DO C`+e or- Ad ess ,4 / Ai C Death Certificate Filed District Number Register Number City,Town or Village City of Albany 101 Date Cemetepry or Crematory. , El Burial / / 7 " t ci r ! U 2 e i Address (� ,. Cremation 2 ` /a �� _ �/ 6 UL� c b u./�`/ p VC (ved / > Date Place Removed Z ❑ Removal and/or Held and/or Address F'- Hold N Q Date Point of O. Transportation Shipment ❑ By Common CI Carrier Destination ❑ Date Cemetery Address Disinterment Date Cemetery Address ❑ Reinterment Permit Issued To Registration Number � Name of Funeral Home C t 0 - 04-e Fukti Y cJ i96 ?>[/7 Address (710 2. C." - 4 - ` e Scr_itrA Jecx_, 0 Ai 5 Name of Funeral Firm Making Disposit' n or to Whom 2c9 /� Remains are Shipped, If Other than Above l `o 2 Address ce IU 0 Permission is hereby granted to dispose of the human rema' ibed above icated. Date //r 7 7/0. Registrar of Vital Statist' a�s Issued (sig ature) District Number 101 Place Albany Police Department City of Albany, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition I fZ)IS" Place of Disposition Z41/1.J Cn "-.. LU (address) W vT _ rr lot number_ 0 (section) (grave number) 11 -ram Z' Name of Sexton or Person in Charge of Premises r; . '`, (please print) Signature tu A 1,.\-. Title lkt 144PIN (over) DOH-1555(9/98)