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Wood, Joyce NEW YORK STATE DEPARTMENT OF HEAL4T} '. I Vital Records Section Burial - Transit iermit f i Name First Middle Last ( Sex NiO yee IAeve.,l4rN Wood F al Date of Death j Age ' If Veteran of U.S. Armed Forces, 011 ra 1 1'4 l q at-- 1q 53 -'i'!!'i �� War or Dates Place gi_ip. ath A Hospital. Institution or City, n r Village rC'\\� Street Address r V.e.e p,O n Q,p Manner of Death®Natural Cause Accident Homicide 0Suicide Undetermined Pending Circumstances Investigation I Medical Certifier Name Title a, Address Vr g('( ex s- -. C�) e n5 Fa 1\s A) L*4cL ;. , Death Certificate Filed District Number 1 Register Numr - : City ow or Village A(Z. ,1 t- S 7so .2(o ( Date i Cemetery or Crematory C Burial dTI 2-0 t a1n_e i_ C M -1 I Address JO Cremation QL S r N , I © I Date ,� Place Removed O❑Removal and/or Held -.• and/or � -_�_____�____ _ -_-._._ _ �_-. t- Address - Hold Date Point of a❑Transportation Shipment n by Common Destination Carrier C Disinterment Date Cemetery Address leinterment Date Cemetery Address .`Permit Issued to � �Fr F�n�` 1 1 Registration Number Nam e of Funeral Home/&k nQ rd home_ of I 3 L Address ii Larai-letk c3+, , 6)i.4f C.1)0a-c- j , AJe.w thic)t L-Lblyi {:i Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above tAddress s Permission is hereby granted to dispose of the human remains described above as indicated. '? Date Issued 9--N-J/ Registrar of Vital Statistics )Y1 c,toAA,o- `l (signat ) 1. District Number cS 7s- Place f-I I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- WDate of Disposition 1'Ig�-i4 Place of Disposition_ ea.,. C,�✓C6d . (address) ' L'^ U3 (section) f (lot numb (grave number) sj Name of Sexton or Person in Charge of Premises • ritt, nrci9 g t' (please print) 44 Signature Title Cilikivvqk (over) DOH-1555 (9/98)