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Galvani, Joyce • NEW YORK STATE DEPARTMENT OF HEALTH 4 1 gg07 Vital Records Section Burial - Transit Permit a Name First" Mi dle ` Last Sex p oyG t= ,. • 6-&LVAA Date of Death 7 Age If Veteran of U.S. Armed Forces_ l /z's /a d r-f War or Dates Place of Death -___ Hospital, Institution or City, Town oVillage ,../C1 Street Address 3I NAM; ) Ave.,,,, ` Manner of Dea - Natural Cause El Accident ©Homicide El Suicide �Undetermined �Pending Circumstances Investigation W Medical Certifier Name Title Address /� `f J i =r Ave, C_..)r.A_.17 ( J, I ) (5a2._-. Death Certificate Filed / District Number Register Number City, Town or Village C...-v r.- A _ Date Cleme ery or Crematory. '(�G. I p�c� / / Burial `t n �v:c .� G�r�M.�-fir �,1 Address L�1 Cremation (�e-e,ti ,r, NL. ,) Y;r� UU Date 0 / Place Removed ORemoval and/or Held 1-- and/or Address - Hold 0 Date Point of U Transportation Shipment Es by Common Destination Carrier ^' Disinterment Date Cemetery Address — Reinterment Date - Cemetery Address Permit Issued to Registration Number Name of Funeral Home,---- - ASM r e 1 ,per.. ( Pam.. G p y < Address 7 / v\,, r i - ,Ave 1 6r _. l\)7 1 �'✓6 J..)- Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address IL, R Permission is hereby granted to dispose of the human r: • • =scribed ov: -s ' •icated. Date Issued 1).4 C/)o'7 Registrar of Vital Statistics I,.i/o _ " ',•a ire) IF Number ( Place /• ,��-✓ /�� L I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I~ w Date of Disposition i 212R 11 ' Place of Disposition Zti...; � ►.c¢o;;.�g (address) uJ CC (section) t n_umber) (grave number) Name of Sexton or Person in Charge of Premises hs iset Z /41 (please print) W Signature Title 01i 0, DOH-1555 (10/89) p. 1 of 2 VS-61