Loading...
Smith, Shirley f I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section !a Name Paddle `C Age Veteran of U.S.Armed Faes. o�of p l Iz.l 1 5- 1 sE . gWar Oates mor Place of Death H ,,inStilgi011 or V — e r'c f - I'1�"3 SleetAddress Co Vc_ `�A->IJS©N t-1vastiN V C `is L Hof pear,�NekRsak ❑act ❑ ['Suicide dd �Circumstances ,; Merkel Certain NOM° rs Tie NC._ -.;' Addleti\5-(&'-l_ \-Z--C a.,c-,L..1,3 ssz,<_,N7.___•-•, 13,-._ \--a. -e)LA Death Ceram*Filed ca-� � �w 0.CL i- Dish"N 5 5 I C� MY.Town or a *jlber - 1 v���o it-`-‘ • Cremation A R-0 7 Qv e e-S�) 2.`-I. ti3k. \ ._$a`.I .•. Date tam c.� Place k�and :)CI Removal I and/or Held andtor Address 3" Hail a �Transportation Date I Point of Common Destination Carrier •-- Address ppiernent paw car Date Cemetery Address lit Issuea te {3a cal Ke e. 1Fkil j� Name of Amend i�ome ancird k _ , Address 1% La. yct-k St - Q q eensbu, N_4t. )2434 Name of Funeral Fern Malang oispoeibon or to Whom __ • Remains are Skipped.If Oiler tam Above Adds - . Permission gran�sd to dispose of to hen r; • as indicated. of Vgai - . ►•V Date Issued, (5 _ _%, '..., 1/Plie ' `555 uy~ ot 7 - I c=ally that In remains of the decedent idenlead above were disposed off in acoordaice w' s p arc Dale of Disposlon 31 I31I5-- Place of n RtlLJ /,r"•71j(N‘ _ (address) 1,,t (section) (gave number) AtcLimber),cik..4. -Q Name of Senn or Pirsoti in Charge of Premises (over)