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Casatelli, Michael
f 044 ti3g NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit gl Name First Middle La Sex <:: Date of Death / Age If Veteran of U.S. Armed Forces, -/y-/7 �� War or Dates Place of Death Hospital, Institution or City, Town or Village 'o,)„.„,, � Street Address Manner of Death Natural Cause Ej Accident El Homicide El Suicide ElUndetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Address ::::.• 3 C45. -Ct-t-•_"---,-. ‘ \1'. i. 1..t)-\..0.K.e-r- /- ST-i'K i;i;.;;.i Death Certificate Filed District Number Regis/ egis r Number ': City, or own Village Q___ . f.C3 6 Date C metery or\Cremato »: ❑Burial ‘ -/7-a 0 /7 x 1.1 � \ ,.,�1 NA, Address ©Cremation \' gDate L Place Removed 0❑Removal and/or Held and/or Address a Hold — Date Point of N❑Transportation Shipment 5 by Common Destination Carrier fl Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to , _ Registration Number Naerme of Funeral Home Q Q..._� 0 0 3 b t7 iiiiiii Address. . LI c\ )-- \'k\cl.t,4K,v ••--Q- CizifrelYt-Te LAS • V h bL Name of Funeral Firm MiakinFkposition or to Whom •~ Remains are Shipped, If Other than Above Address iiii Permission is hereby granted to dispose of the human rem s d- -crib b s indicated. iii Date Issued 6-/7-/ t-/ Registrar of Vital Statistics Viet-- (sign- e) District Number 5' 3 Place ,..�)1• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: iF 5 Date of Disposition idIc/14 Place of Disposition et70.404.0 C"-4(v- 2 (address) LU Cl) LC (section) t number) -net* (grave number) g Name of Sexton or Person in Charge of Premises Mt- (please print) Signature dfr9L Title CO/-4,I- (over) DOH-1555 (9/98)