The URL can be used to link to this page

Cuthrell, Stephen NEW YORK STATE DEPARTMENT OF HEALTH °' '/ A ' Vital Records Section Burial - Transit isermit , Name First c \ Middle �1 e\c-61 S iRN :.y..;. Date of De©h, ) 9-0Ages 6 If Veteran of U.S. Armed Forces, War or Dates (q L 5- 4 b '; Place of Death Hospital, Institution or y� c City, Town or Village Street Address "�'o` `� Manner of Death M Naturalise 0 Accident 0 Homicide 0 Suicide 0 Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title \ ' ) �� -\ _\\ 'M ':> Address I% !G obik v 1p`\f C_ (or, IJ1 i g-�`�'D' Death Certificate Filed District Number ° Register Number City, Town or Village Date ' 1 J C etery or Crematory ❑Burial \ I ., i Q(JJ Li t r2.)a e_g_. > Cr:-.C.vNt\cAO'.."\-6 Address zi.Cremation c ROCA C;)...e_19 --\. ts 0~ , 1 axoy 2 Date Place Removed 1� C Removal and/or Held and/or Address >t Hold 0 Date Point of %Q Transportation Shipment 5 by Common r Destination Carrier ^' Disinterment Date Cemetery Address — Reinterment Date Cemetery Address Permit Issued to } Registration Number 1{' Name of Funeral Home�>il•5v-1O _ Cv.n�.r-- ` -t(-{S >; Address v'Icr UC- CD,-'\ -, Pl, la 2D-Z Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby ranted to dispose of the huma _ ains d=<c.ed •ove as indi ted. liili Date IssuedO' 6 Registrar of Vital Statistic ��ks 1`V � s�li '`'`' (signature) � :, NA District Numbe a, Place \ e°30zU` I certify that the remains of the decedent identified above we osed of in accordance with this permit on: 6 Date of Disposition I/ JM Place of Disposition RN.d,t1.3 Cwv(At';L _ I (address) 111 (section) (I um er) (grave number) Name of Sexton or Person in Charge of Premises �f.ilip" _�t% g (please print) 11 Signature Title trlit/ 'tait- (over) DOH-1555 (9/98)