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McAloney, Charles
lt lop NEW YORK STATE DEPARTMENT OF HEALTI '' It Vital Records Section Burial - Transit Permit Name First Middle Last ` Sex 1 4� e CkA ABLE 5 ,ANTIk t,3 tM LA L-O tJ EA —� Date of Death A ' If Veteran of U.S. Armed Forces, 10 /(o/ a'.o1y War or Dates N A - - Place of Death ' Hospital, Institution or g___ City. Town or Village-Tx'© 31`� Street Address iS 160C. ��v e • Manner of DeathUndetermined Pending it) �Natural Cause �Accident �Homicide �Suicide � � Ili _ _ Circumstances Investigation fil Medical Certifier Name Title Lees 1�i`�1 A N t E Address f SiD ' ,1"-OcA, s- e,- SA , 'A la \gig Death Certificate Filed `� District Number Register Number City, Town or Village / '/O Z ,.�,.lp Date0 i 114 i : Cemetery or Crematory Burial pi+��‘x �cc_�c-. `� — — - _j i Address � 0-�C.\�._r CQX. apt s� i�� Iagoy I^.�Crematooy! „� r Removal _ — _ ---d — —' ' Date Place Removed —___._ ---- Z — and/or !eici �'—and/or � ------- _---- - --- r,;( Address -- Hold IDr- _ _- ------ --------_ O Date :_,irc _If N —Transportation : Shipment a by Common Destination Carrier LiDisinterment Date Disinterment Address —__ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home /C +11iCt'C( (-) I czik-c I f rule"cr./ ,f f c cY)L Address " I( LCkit act'L.l7C ,l)ri , &t..ct -)sia.trL , !UP t.,u /U'l- /:al,�-)`f Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above j Address --.. __ .. -._._ Permission is here y granted to dispose of the human r 'ain d rib abo a as indicated. Date Issued is / d< Registrar of Vital Statistics (signature) District Number _40_WO y Place 1----__/7 _e/ -------- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: P f-- i` Z Date of Disposition itti/iS(q Place of Disposition e Y re ;."-- 1�W (address) --------------__ i tt) >i (section} ''lot number) r (grave number) 0 Name of Sexton or Person in Charge of Premises _ r_ .+ ,2 (please print; — ti W Signature 4 4.-- Title ObEntill0K .oven DOH-1555 (9(981