Loading...
Cronin, Doris .ft i7 NEW YORK STATE DEPARTMENT OF HEALTH C� Vital Records Section Burial - ransit Permit <. Name First Middle iv\ Last I Sex Date of Death a i Age ! If Veteran of U.S. Armed Forces, © l 10 12 o 15 -62 ` War or Dates IA Place of Death I Hospital, Institution or _6 Ci))Town or Village San a S(kinOvr I Street Address )- 1 LCxta)r•ence 'SA re e-- Manner of Death aNatural Cause fl Accidt n Homicide l Suicide in Undetermined pi Pending Circumstances Investigation Medical Certifier Name Title 64i cY-\ D. Tee4-Z 1`A b ; Address ±t' 15\ L.ck.wr-evIcQ S‘r- . n: Death Certificate Filed,,, i District Number >.::�< .. • own or Village , e,�arr G ri A - ' Register Num el n Date I Cemetery or Crematory I 411 I (Burial Oe I II I 2.015 1 Pi1r)f v 1eL0 Cremes ( Cremation! Address ` �{ QU O4'(1_ v K Ni \ZC)z} Date / 2❑Removal Place Removed and/or ----__- _______-- ; and/or -!eic� Hold Address Ch Date — J-- a 0 Transportation I j Shhip�ipment c. _ by Common Destination Carrier I I C Disinterment j Date Cemetery Address :-:> n Reinterment Date Cemetery Address Permit Issued to ik Name of Funeral Home Baker � ec�� name_ I Registration Number M. Address i( LC`rQ' mac. A � ; CI 1 3U yCtte v1 , &(,kfcf)SbLi:rC,( lieu} Vac)k- icV0y Name of Funeral Firm Making Disposition or to Whom J Remains are Shipped, If Other than Above -:Tr Address IR .B< Permission is�h e granted to dispose of the human remai scr- ed ab ve indicat d. _` Date Issued s 1 / Registrar of Vital Statistics (signature) in District Number y Dj Place 3,0ciArcx-rk 39Sl1A..'LJ-) ) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- 6 Date of Disposition ' l ii i 5' Place of Disposition , ,,,, �' � IL (address) >n Z Name of Sexton or Person in Char e of Premises (section) (►tot_nsber} (grave number) ��)�yy 94 Signature A (please print) 'j Title 0,1; - (over) DOH-1555 (9/98)