Volino, Lynn . . 4 6VI
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
plii Name First '`n�� Middle on Last 1 !o i )n O Sex F
Date of Death q I 'tsizU15 1 Age all
. If Veteran of U.S. Armed Forces,
` or Dates
14 e of Death Hospi . --InstittitieFFeF
city, r- aae 6len 5 F-oJ-1% I : C-► I er>s Fo_A i C
141
anner of DeatJ'r J Natural Cause Accident Homicide 0 Suicide Undetermined �Pending
'� Circumstances investigation
0 W. Medical Certifier Name Title
a
Address
h Certificate Filed District Number -- 1 Register Num r
Ci 6 S �a�li� S 6 0/ L/j
h. 1 Date q ` , 1 aO\cj I Crematory p v-‘2 Lk.❑Burial 1 1
Address /.� � n d , /�` � �
�remationi Ul t� � � 12-SOL
Date Place Removed
Z ❑Removal . and/or Reid
and/or Address ---- - _- _
47- Hold
0 ! Date - -- -- quirt or
NE Transportation { Shipment
E by Common ( Destination
Carrier
Disinterment [ Date Cemetery Address
Renterment Date Cemetery Address
,!. Permit Issued to �AkeY I Registration Number
Name of Funeral Home r Patera) dome- i O\`30
gilil Address 1\ LGScNy e S e e-- Q u.eeysbttr.y N-f 1 Z?0L4
>< Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
- Address
a.:
.Ki> Permission is hereby granted to dispose of the human remains desc "bed abo as- i ted.
i` Date issued .*.//Z0%S-- Registrar of Vital Statistics 41 `L
'�'=' (signature)
O-v 50/ G ,// A)/
'���`�: District Number Place S,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i
i q
Date of Disposition 1ICIIS r �,
Place of Disposition 17ini(Iv-)
2 (address)
th
nC= (section) A (lot nu er) (grave number)
Name of Sexton or Person in Charge of Premisesa,tvl. „noN
(please print) i
. Signature L Title ffrN I
(over)
DOH-1555 (9/98)