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Argila, Jowina
NEW YORK STATE DEPARTMENT OF HEALTH , Vital Records Section Burial - Transit Permit Name First \ �,nc Middle Last n ,1 Sex p. Date of Death Age If Veteran of U.S. Armed For , 4 ©g l o3) 2.0 C'10 War or Dates K IA Place o th q Hospital, Institution or €w� or Wage C �1 rdensCU( Street_ Address W eS'�U C U f)4- Manner of Death Natural Cause Accident []Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Address ((��, ,l "1 C csi e`i -WWoos-u Cl Q9' \1ur�-r K \"E-8 O`1' 40 Death Certificate Filed�, District Number Registr Number l City,C .ior Village t�(X.)+l\SY1U r y 5cpS1 CI`f t-� Date Cemetery or`Crematory [_Burial DO''DUI I Z-G1 �i+�Q VI eU3 Crema+ory Address :;:: Cremation Q�aQonS�txYy, �� Date / Place Removed ❑Removal I and/or Held and/or Address Hold 0 Date Point of s ElTransportation j Shipment a by Common Destination Carrier : .Q Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Ma na 1d a= ker Fu necc-I home_ Q!)30 •-- Address // Lana-yR,tte vi , bue.eJ s&Lr / I New LJUrk I g BUY f Name of Funeral Firm Making Disposition or to Whom Xy Remains are Shipped, If Other than Above •y5 Address ai , - . -�. - . . , as ii=dicated. � . Permission is hereby((granted to dispose of the human r� a , , •, Date Issued -R - 1`t Registrar of Vital Statistics r 0, ( : ature) District Number laS Place 40t,u- ,\ ' IN-l I certify that the remains of the decedent identified abov ere disposed o -n accord with this permit on: Date of Disposition Sh/ly Place of Disposition tL (address) u. m (section) / lot number)- 4 (grave number) Name of Sexton or Person in Charge of PremisesCI G ' — tJr"►� (please print) Signature �� 4 Title cixehprice (over) DOH-1555 (9/98)