Tortora, Stephen (T.--4: 32
NEW YORK STATE DEPARTMENT OF HEAL,.
Vital Records Section Burial - Transit Permit
Name First Middle Las,t( S x
Date of Death Age t If Veteran of U.S. Armed Forces,
i—\'3-- 01'c • War or Dates ✓l
#- Place th Hospital, Institution or , - �,cj i
W City Town o Village C, I,Lee,vtsi0vtf W Street Address S , e51- l-xc�t-
o Ma gr.et15'eath Natural Cause 0 Acc dent 0 Homicide 0 Suicide El Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
a l,wl,v Ai�rpk L'
iron 6-r'
Address
,-:,,10\ 5 et V
Death "ficate Filed \ District Number Reg 1410...9‘._. A--vp „,,,a,,,, c._ �istSN ber
City, own r Village _''1��.,,AcAk,4' , �(Q�
❑Buria Date C etery of Crema vy
['Entombment \—,1 c O I h,L V LL,.l) 6'Q,►M r
LA
Address C (tc-/-14-rt.A
.� �Q ,�
Cremation ) Tva(11 (...ect/I4) (' 4 a tD-Q4
Date �� Plac Removed
Z' ❑Removal and/or Held
and/or Address
F=`" Hold
(t)
O Date Point of
ft❑Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to �, � r ')j Registration Number
Name of Funeral Home ( °kv` `E_SS;zrilcc-t-a✓ /cin.t� L ar- .�- c... (bn 4-
Address
'-{oD, Nal0.4)I0, VAv k a41 , C" u ch in
Name of Funeral Firm MakinglDigposition or to Whom
1,- Remains are Shipped, If Other than Above
• Address
ix.
w
P? Permission is hereby granted to dispose of the human re 'r` escr a ye indicated.
Ei Date Issued t—t(e- IC Registrar of Vital Statistics Vt) &J al
(signature
District Number
��`sii Place Dlv-\ 'Th )tk.ftin4 it,LA
certifythat the remains of the decedent identified above we disposed of in accorda�is permit on:
U p �(
lU• Date of Disposition I/lok Place of Disposition ZGti' C ,r...
(address)
LU
Ul.
CC (section) j (lot number) (grave number)
Ci Name of Sexton or Person in Charge of Premises � '' "Amr-
( lease print)
41, Signature 64: � Title LZZfwt??►�iZ
„„„„,„ (over)
DOH-1555 (02/2004)