Vosburgh, William NEW YORK STATE DEPARTMENT OF HEALTH w 1 # 353
Vital Records Seon Burial - Transit Permit
Name First • , Middle Last Sex m
W alit aro ---T: VobLifq)
Date of Docito 611,4 aus/ Age 85 If Veteran of U.S. Armed Fdes, iy
. War or Dates /cOrerk..
1..... pl„,, ,,, nr,-11-1, ^) Irnnit.11. Inititution or st a b
s rafto "ic a,u2..12.mbuf4_ (Stre .5 uu..,et Addr2p Carl COVe—
WI' 40:-
pi anner of Death i7+1, aural Cause Accident I I Homicide 0 Suicide ri Undetermined ri Pending
WS "J Circumstances "'Investigation
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uj, Medical Ceitilier N:tif-le • 1 Title
Ci. irrtnOrl y r—Pf-fraCCa /VC1
AJ4.1c,Ss i
Irokr9A Can-ier 61-etialolliFAN, i261 I
Death Ceriticaii? F;l,o ", D lot Number Register Number
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c,v,Cr..c...,.)r-tt177-
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, Bilrial Date 61-1-4 Q013 6eilteter remator -71
1-1(\e- Vleui
i IDE.htorni)r-ieni
As:iioss
1 0C-ernatioh (-)Ua-k-e' RCL) QUeencL-, OW la,( 0(-1
1 , _--:._:.:? Place Removed
10Z ,L_jr—' Rolu,,'.. , and/or Held
— anti
— Hold
Cl)i
0! - IT , Point of
-,-ca.,r
Ito,L , 1,,,ir,„! -;,%,,n - Shipment
'-- . •••-' Dostir-,ation
Daio Cemetery Address
ElDisinie.wont
Datrr ' Cemetery Address
F.- P:,---)!mit ! , 1,,, Registration Number
Name of Funior.,.-ii •-1 --.-4e r . . . , -.,, ,i ;,,, 4 -_,, , f,, _; I ,._. , iL i-i.:_.4 kAoryc_. , C-) 1 1 3 0
Address
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, ,'. C ,-' .i ir,., i s,, , \-j (•: ‘.,--.....4 lur (._.. 2 si 0,--\
N,ime ----tc4--.-2i.lr. ir-•: m Making Disposition or to Whom
i---a Remains are IT . li Curer than Above _
* Address
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Lii
CA. Permissic,r 's r- -..r- oy granted to dispose of the human remains described abovei s indicated.
r).:1 0 i _, , (1,i ic)013 Registrar of Vital Statistics
, (signature)
------
District N.r,iii,ki, Place i0 .1 c (.- au.....2_32,,,L
,,.:, r111„, y, _yt ,.. , n-4aii or the decedent identified above were disposed of in accord nce) ith this permit on:
ILLI Date ot IT - -In Wit la Place of Disposition -0404.4 rtweitif,N.—
11 (address
14
;i,.....1 isection) lotflumber) (grave number)
10!
Na-nt of S-xti-4:4 in Fe.iss irl Charge of remises ittr SenAttt
1-4r (plea e print)
I- IT SicillatJ:, 1S1-- Title aCerrq,
I -
(over)
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