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Coletti, Josephine
NEW YORK STATE DEPARTMENT OF HEALTC.1 1 # tit Vital Records Section Burial - Transit Permit ra; Name First r< `` Middle t J r; arit.J is I)4YLoA) t a 1 Sex Date of Death ) ©L�'TT-�/ j ��s� �r Agee ! if Veteran of U.S. Armed Forces, �`/3/ f/3— 1 // War or Dates 44 Place th �/ i Hospital Institution or City, Town r Village U ,,i.S 3 U Street Addres / � iz Manner of Death �►1►�( '� r��/ ;' (�-T �(Li U c� Natural Cause E AoEident , Homicide f Suicide riUndetermined +Pending4.3 Medical Certifier Name Circumstances Iill 'Investigation Title Address ` bti , ig Death Certificate Filed / c , / 0 v�'�6 /V ; City Town r Village t.12Mber { R s er N ber Q U EONS Q v y� j Date �J—/ Cemetery Crematory `J Q Burial I c�/�1 Address _ +' l^) v' 61,0 rem anor, n 1 QUA - ❑Removal I Date Place Removed 2 and/or and/or -!Lice err t Hold i Address — - - ---- — + ! Date ._.-- ---- - - -. -- - of N U Transportation i lhp a by Common Destination: ` Shipment Carrier •;-: 1 ;Disinterment Date ; Cemetery Address :.'- Reinterment E Date ` : Cemetery Address Permit Issued to • • _ !Name of Funeral Home Baker FLU-Te ca/ f_ocy,e 1 Registration Number II Address - - rGI ) 3(� Name of Funeral Firm Making Disposition or to Whom ..'" Remains are Shipped, If Other than Above aAddress Permission is dispose hereby granted to 41 / of the human re sins described a ve as'indicated. Date Issued L lau/i Registrar of Vital Statistics (. (sig tore) District Number S '") Place l O�-� O- L I certify that the remains of the decedent identified above were disposed of in accordanc with this permit on: ii Date of Disposition 9 l ti l lr Place of Disposition ►mac v Ct' gOr �wc l iLl (address) gn Name of Sexton or Person in Charg of Premises (section) / {tot number) (grave number) J +'1 U. Signature /# (please print) Title j17af,n F (over) DOH-1555 (9/98)