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Ovitt Jr, Thurlad Air- NEW YORK STATE DEPARTMENT OF HEALTHI 30 Vital Records Section Burial - Transit Permit N�ame� First fiddle Last Sex '.Date of Death Age j If Veteran of U.S. Armed Forces, - 2 - 2l� 41 War or Dates No } , Place of Death Hospital. Institution Yo i� or Ci j. Town or Village S r i n5y Street Address1 �� s -� I - Manner of Death`(Natural Cause ElAc 'dent 0 Homicide Suicide .determined 0 Pending Circumstances Investigation lj Medical Certifier Name Title Address Death Certificate File District Num r Register Number Ci , Town or Village r p� C t r\ ( L 1 2./0 Date pimity,or,Cremator6x.e_ ❑Burial .1)jjT—ZZ?C1 S 1 .W----- Address fid Cremation{ Q1I-D* .__�,. ,._ Z Date J Place Removed O o Removal and/or Held and/or Address Hold O Date Point of NL. Transportation Shipment G1 by Common Destination Carrier Disinterment Date Cemetery Address Date Cemetery Address El Reinterment Permit Issued to I Registration Number Name of Funeral Home �'e,,l� +,i'LL r-raL 1_.-fyyi in L ©01I Address Name of Funeral Firm Making Disposition or to Whom a Remains are Shipped. If Other than Above aX Address f Permission is h reby granted to dispose of the human remains described abo / ' i d. ;.1 Date Issued Z-Z.. ( $ Registrar of Vital Statisticsregilit..., ci— ��V T (signature) District Number S b( Place I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i- p DILIate of Disposition "Ii t1iy Place of Disposition 1'oAlLf el,,., 2 (address) W N CC (section) ,blot number) (grave number) L Name of Sexton or Person in Charge of Premises I( ..St two- 0 " (please print) Signature Title lilt DOH-1555 (10/89) p. 1 of 2 VS-61