Lanfear, Alfred ir
11TS1
NEW YORK STATE DEPARTMENT OF HEALTH •Vital Records Section Burial - Transit Permit
Name First i,fiddle Last Sex
Al-'red Lan reai .. M
Date of Death I Age Q If Veteran of U.S. Armed Forces,
O1111 lZU)4 War or Dates IC43- 1cA45
1- Plac- • Death Hospital, Institution or
5 C- ' s r Village ICU,ecf$1puYL/ Street Address Slav cc n g- -H
W Manner of Death -0).- Natural Cause Accident 0 Homicide 0 Suicide Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title ;
CI \C(C v 3Ov 0O/-, F D _
Address -
C\ Cps g )D6 Jl9f1Sbl�Y t�( i?�0)
D ,• icate Filed j District Number Reiter Number
. ,Town r Village �u..Q.sz....tNlh I j( Q' ' '- ilk y
❑Burial Date i Cemetery or Crematory
o� 11y � � r5 pine Alley Cc ern a fy
❑Entombment Address
5Cremation Q ,,co(„i,i i(t o• i Q -Qfi. 13ixr ,') 1?z0,4
Date 1' Place Removed
Z Removal i and/or Held
2I-I and/or Address ' •
Hold
0 Date l Point of
Di Q Transportation 1 Shipment
3 by Common Destination
Carrier
Disinterment Date ! Cemetery Address
Q Renterment Date Cemetery Address
Permit Issued to i Registration Number
Name of Funeral Home 1,4 Gy nu11 , (Sck ker F c r 1 irk);Y1t-- L 01 3C)
Address
i1 Laickyce S. , 2,kccnSbL.(y , tiev-1 '1c,r 12sio+-j
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
Address
CC
lai
CL' Permission is hereby granted to dispose of the human remains describ d
above as indicated.
Date Issued 1.1�-1 E 1 Registrar of Vital Statistics c Q
(signature)
District Number c(4') Place $ 6. ct�.s?.,��
1-
I certifythat the remains of the decedent identified above were disposed of in adance with this permit on:
ILI Date of Disposition -)-110-14 Place of Disposition 'Pk, ( (1--/
(address)
1ii
tc (section) 1:39_,(lot number (grave number)
QName of Sexton or Pers n in C arge of Premises e"`'et
Z Z ase print) ,
Signature Title C it
' (over)
DOH-1555 (02/2004)