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Sayre, William t N. M778 NEAP' YORK, STATE DEPARTMENT OF HEALTH Vital Regerds Sect'Lir Burial - Transit Permit ..._ _ Nair40 Fir sr— 1 1 CklY\ E \I rc t Ast SPY Dare IA c,i.miti (IL, It Vclooad of l.,1,5 AIMnd Force5. 3 -..,.1;,7,a-ts I* t -yVar Lri Dates No k.e. i 1— Place of Death c--„ -,-.espital institution or Z CAN Town 0!, Viii-igp._Th t) ...clii'f-tykiCkS Street Address isioe5IN 1-e_a.1,14,... Co_re_ 0,,--;-D, 34 ' . - - . L-j Acn armor Undetermined 1--1 Pending 10 rjr 1>n°' Nt Tg aur al Oat ,,e 1-1 icir.H ri Hr.:mde 0 s u loci. AJJ _ Cirrtr;m&tanc.es L'—' invnts.trgation tu Men.,;.:al Certitn7-1 Nair — , 1\1, i. Title I , , Address ,_, (\i . 30-4.--cc+f)50 . ,0 i) \J i ‘ ( Death Certficale F11.2i1-\ DI m tA' GI Nube! . Fed NJrnbei 1 Cry 7,-) ,,1 or VI,iltp..3aff..A.--1/41)1 Cl f car SD c i 3 2 El Burial a:. 11 -/ ILI- t_d Cni,:tery,ciCrem ry z rIv,Elctirier:nimm.oh:::.:::1 ...c#,:6u.„.5ejty\6bu 9 f\I piacc, nr,ii,d,or Held over rI 04 I—I Addrest,, Hold , ',..C) Date f ill JI ,a. E T ttn ,rafisportattor Snpment a by Corrimori Dest halm ri Carrier DatF.f. Cemetery Address D Dis-irtorrneiit Dail-, Cemetery Address TiHeirilernient ..! Rt-ffm,r Issired to ...._rp Registration Nurrib4Z" i Nall IQ or F u(1,, t.al Hoirk, reir• re,•)c-r- "" ...t.r\e_x-0,,t 40 yN6.11 \YNC., 0(9.d-I I .....______..... _. _ . ,__ Addi ess (1.4- Ckur-ck Si Lctja_ f\j\I or Fu neral Firm Potalung oori Disston oi lo Whotn f— Remains are Shipped. tf Other than .AM-1.,e. Address CV t Permission is hereby granted to dispose of the human remain r1bp1J abort, dtcata 1 . ! Date Issued5/19-17_014 Regis...n-1J of 'J./4a! Statistics i ry,-•,...vt.,!c-, i i Disinoi Number 450) Platt:J.' SAratzia„,.., Sex-fr‘ _ _ _ _....._ .... ,___....._ I I-terrify ',hat' :tit- rornains rf fhp docrden- idenrited at-..ove were disposed oi in accordance with this permit on. Lil Da:L. cif Di...'licitiltion_.?—/g—(V piou.„: .,..,- Diszio , piql/vC V/42ti ao-kfiefivey 2- ,,,,,,,„",•et,, La gg t Name o' Sexton Per: n 1rqe cf.' Premses Z S,gnature ,, ,1 / W 1- e91 Tithe CjO7d14l'c:4a17,0 c 1i • .. 1:•.-itoer'/ 7.,,OH-1 55'5 :02,20041