Cammarano, Aida 1
NEW YORK STATE DEPARTMENT OF HEALTI- ' 8 n 1 Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ai`ctCU ea--rrt rrCi.rc 10 o • I•v,,,12..—
Date of Death Age/ / If Veteran of U.S. Armed Forces,
(� — Q-S a C I� lD f� War or Dates AM
Place of Death r Hospital, Institution or
City, Town or Village ,3G`t tooth Street Address ,a'‘ S Oa F fai4Li
Manner of Death,,Natural Cause El Accident ri Homicide El Suicide EiUndetermined 0 Pending
Ul Circumstances Investigation
W Medical Certifier Name Title
0 A r ca '6.6.-i 77-1 r✓w b.Ss m 0
Address
I o a t p AitI .. STree.T C,tetos Ft-WA AI ,. -I ako/
Death Certificate Filed District Number Register Number
>< City, Town or Village Sc 4 t---p p /—<G3 a....
❑Burial Date //'� A etery or Cre atory ,.-
<i ❑Entombment V 0�P O`'l y tee' (r e t� Jt 51,
Address /1
511 remation It G e e NS 6 ci.a^�/' NK '
Date Place Removed
❑Removal and/or Held
and/or Address
t Hold
'I,
0 Date Point of
❑to
Transportation Shipment
G by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to �� l Registration Number
Name of Funeral Home r:wo ll h_ �y f ierg( h7'yy/_e_- et;-5 L b
Address
sal_ary._ ki\t6c_ Ai .. j xd 7&
Name of Funeral Firm Making Disposition or to Whom
)- Remains are Shipped, If Other than Above
• Address
ft
fl` Permission is hereby granted to dispose of the huma ins described ab a as indicated.
Date Issued d/-06-,)-6 1 f Registrar of Vital Statistics -� /1�Q
7
(signature)
District Number Ib( 3 Place Y .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
t1 Date of Disposition 1/7 1111 Place of Disposition . , Li °LL,.
2 (address)
til
CC (section) (lot num ) (grave number)
0
Name of Sexton or Person 4n Charge of remises t,ii tot' f.as1
Z1 Tease print)
_I Signature '. � Title �'1R
(over)
DOH-1555 (02/2004)