Loading...
Murray, Joan NEW YORK STATE DEPARTMENT OF HEAU11-i 1 t(or Vital Records Section Burial - Transit Permit ,- Name First Middle Last Sex. xl Cord tl ca cA rro..( • O�1 Date of Death Age If Veteran of U.S.Armed Forces, O} ? \O —(g War or Dates NO nstitution or ` Place Death« own Or Village Gl e Val\S Strom Address ess (\er1S a\\$ �S'.?►-1 .1 f•, Manner of Dr ug[ Natural Cause D Accident ❑Homicide ❑Suicide Q Undetermirmd ❑ed n i Investigation r Medal Certifier Name Title Marilew Vo.rulneSP _,Ae a ;r PY14s,c; n :Xf, Address J \00 9ac1- err-e—e --� el'-e s otl\s/__A �. t Z$al '� Certificate Fled District Number Register, iu sber , City >• or Vie lens cal\C 6,�' / Date Cemetery or Crematory Q01 1 61 \ I-01`{ P;n e. \i;etAN Cr orna E-i Address =:lA4 Cremation ‘A.61\er - (-beck Date Place Removed o Removal and/or Held 454 • and/or Address I*1 Hold 8 Date Point of `.[J Transportation Shipment ii by Common Destination Carver ::0 Disinterment Date Cemetery Address ': Renterment Date Cemetery Address r s Permit Issued to � Registration Number >:, ii ff na..rd 6_ der Funeral Horne_ ,�� Name of Funeral HomelhQ� O!13O Address /i L_ a-yR#e of ,6 ul ens "Cd t fie w go/1- 12 801 r Name of Funeral Firm Making Disposition or to Whom : Remains are Shipped, If Other than Above Address w Permission is granted to dispose of the human remains described above as indicated. nr Date Issued ly Registrar of Vital Statistics WfX.4).-vvt,-'1A.1r1/- - _.. r`r / � (signature) District Number cd/ Place ‘k`2J/%/J '"/ ,' , I certify that the remains of the decedent identified above were disposed of in..accordance with this permit on: Date of Disposition i s i o,11 Place of Disposition '�'of L Cam!`-- (address) .0 (section) (lot number) (grave number) e Name of Sexton or Persj ' Charge of Premises /LAIL S°`'A © ease Signature - (please Ti C 1` , 4 - (over) DOH-1555 (9/98)