Maresco, Anthony NEW YORK STATE DEPARTMENT OF HEALTH -A q 4n-
Vital Records Section Burial - Transit Permit
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�: Name First Middle Last �
=v• 43- LA rJ� C. (a S PE M-AR SC 0
>:::: Dateof Death Age I If Veteran of U.S. Armed Forces,
"? D / ( - ) aa\s (0'3' i War or Dates
it-4 Place of Death IHospital, Institution or 3Sr-'t w S-r- %nc-m-c L& 1-311,L
City,Town or Village St- Qc t&( S -i t-'t>S f Street Address C(\4,Q_LI: S 1--VP\)E-t SQt.►1-1Gs IJ i
ti Manner of Death SNatural Cause ❑Accident 0 Homicide D Suicide n Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
.,1cr`(N1 ZaonE IZ_O MD:ii} Address 6 met^ cc( Pcrit AI- MALra, Ptt t a_Dad
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Death Certificate Filed j District Number Register Number
`'''>: City, Town-co-Village-",,ESL )99 t Aj,,3 ! y S-b) 10
Date ba ) emetery or Crematory
y ❑Burial o a ao \.5 y i i E V \ .u) C t2-c oi rr D z.Li
Address
®Cremation C vAILE R C2-C)..A7 Qv+-CI.DS QvQ.`-k 1)pk-1, \ �S0y
Date II Place Removed
0 Z❑Removal i and/or Held
and/or Address
Hold
3 Date ! Point of
0 Transportation j Shipment
Et by Common Destination
Carrier
0 Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
gi Permit Issued to Registration Number
AName of Funeral Home Nail/lard V_ Raker Fuj era Rome. Of 1 3C)
`" Address i/ La dtC (Y. , 0 U.Cfic)SWild i /jl?w Vor)t 10.??0,1
`, Name of Funeral Firm Making Disposition or to Whom
"" Remains are Shipped, If Other than Above
11 Address
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Permission is h reby ranted to dispose of the human rem ' es ibed4ov as indi ted.
a. Date Issued 17- S Registrar of Vital Statistics
(signatur )
r:x v I 4 Place �/�C�s�t��l�/� 2-W Li)
s District Number y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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EDate of Disposition Zt\3`1c Place of Disposition Q,,Uw✓ C,,. e4cr.u_
2 (address)
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lb
�, (section) (lot//�tuber) (grave number)
,.....,CC,
Name of Sexton or Person in Charge of Premises U1f.g
11 41.,
Z (please print) .
Signature
4.- Title ►41, X
(over)
DOH-1555 (9/98)