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Lynch, Maureen NEW YORK STATE DEPARTMENT OF HEALTH #27 Vital Records Section Burial - Transit Permit Name t t)r'-9_,Iti k y A)ast G ii Se1e...4-i/A/Q _- MA ig Date of Death ' Age N If Veteran of U.S. Armed Forge�,6 ili ei '-1— o'Z f-- /y lO War or Dates Place ath Hospital. Institution or Z City, own o Village Mackzfri 4 Street Address oZ ci Cr- i f'1 la © Mann eath k'Natural Cause 0 Accident E Homicide E Suicide C Undetermined Pending Circumstances —Investigation iuj Medical Certifier / Nam Title .e.,i-luen> pry 5,,...,!,,,,,i Address Death Certificate Filed ' District Number Registerumber City, Town or Village f. e /� Ce tery or Cremator Burial ( Date ei — 6A7 — 1 Bl ivelirt...) 9-,,r. Y)/' Address :.:. rriation v titio-s c>r7 /UTx' Date Place Removed O — Removal and/or Held - and/or Address t Hold 0 Date Point of NE Transportation Shipment E by Common Destination Carrier ii Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to I Registration Number ii '<'1 Name of Funer m A!^cL rV , �/v- npe,*( JJptr2e .St y Address /6 / n 7o Name of Funera irm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described ve 'ndicated. Date Issued 6 yl i0o ! Registrar of Vital Statistics C� t (i�;4;.ry;.� Y ((signature District Number /55 Place 9 ive,i)( amb� /1f. t.>fi` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i® Li Date of Disposition -_3`I j' Place of Disposition Ale-V/4J affit,A1A 2 (address) N a (section) )nu ber) (grave number) 9 Name of Sexton 'Re so i harge of Premises �"o /04vi Z (please print) Signature ft Title 6., ' / i• (over) DOH-1555 (9/98)