Finkelstein, Deborah •
NEW YORK STATE DEPARTMENT OF HEALTH Zs'
Vital Records Section r Burial - Transit Permit
Name First MFddle Last` / S
Date�)De mCi fi 0ilS¢C6n ex/iv4lAge If Veteran of . Armed Forces,
Z//7/ Za/y 59 War or Dates
}- Place of Death / Hospital, Institution or
Z , Town or Village (j/e C` Street Address \ a //9/
O nner of Death I,Natural Cause ❑Accident ❑Homicide 0 Suicide 0 Undetermined ❑Pending
lW Circumstances Investigation
tu Medical Certifier ame Title
0 &/ iQc 1,&2�n my
Address
11
rl /7'w t J Jo(.6%-4,,,r /V y /ZYc2��
Death Certificate Filed / District Number Register Number
City, Town or Village G,�,/j /f l 5 6 o (.
❑Burial Date Cwnetery Corr Cremator'
❑Entombment Lik(//I ` `ii) " 'et✓ l '-C/Y4st 7
As dress
/
: :Cremation ,0y )P('/)S40 ry !vy 7 g:3y
Date Place Rerhoved
Z El Removal and/or Held
2 and/or
� ; Address
U
Hold
O Date Point of
Iwo Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
,h / /2c Name of Funeral Home ,K- 0,,,,,./ „ / 66677
Address6
j4/A-44)/ SI . doi-fie,)_c- tn,- •
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
• Address
I
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ti' Permission is her b granted to dispose of the human remains described above as indicated.
Date Issued Registrar of Vital Statistics i-.it;l?'r1-WI
(si ature)
District Number 56 C j Place 6 (CMS Pot I`S
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:---~
p
t Date of Disposition `IIKbW Place of Disposition t'.,.N�.. C,-4a i.---
2 (address)
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CO
fr (section) (lot numb r) (grave number)
a Name of Sexton or Person in Charge of remises 11
" '4
2: 1 (please print)
ILI
Signature 4�— Title C44EAZ12
(over)
DOH-1555 (02/2004)