Snickles, Elizabeth ft
NEW YORK STATE DEPARTMENT OF HEALTH . ���
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
&11- bed, m . S,, c [CIeS FPv .d-e
Date of Death Age If Veteran of U.S. Armed Forces,
6_ 6 - 20 i 3 71War or Dates
i : Place of Death Hospital, Institution or
CitIiiiy, Town or Village 3o-ro- g05p, Street Address JC(act.ocek
Manner of Death Undeterfinined ending
Natural Cause �Accident 0 Homicide 0 Suicide
ii Circumstances Investigation
tu Medical Certifier Name Title
Addr6rss
66 ' 041-iT�Qv�• 8 i i 1
/L/ AiDeath Certificate Filed District Number Register Number
SARATOGA SPRINGS g
Ci Town or Village 45 1 I w
[]Burial Date Cemetery or Crematory
6 —/p. — /3 Ping. vs'e w CPe""r1/44_eir
li
❑Entombment Address
Cremation 7. 1 0..icor Rd. .e,P_.et S 4 /Z a
Date Placee Removed
❑Removal and/or Held
2 and/or Address
t Hold
0 Date Point of
tL 0Transportation Shipment
G3 by Common Destination
Ui Carrier
Q Disinterment Date Cemetery Address •
Q Reinterment Date Cemetery Address
Permit Issued to tt Registration Number
Name of Funeral Home CO Yv poSS c
i 0.. ..14e Fun eir q � r e 0 0 r(
is Address
W° a m� le. 4ve , 5-3.x Al / 2 t C6
Name of Funeral Firm Making Dispositi n or to Whom
Remains are Shipped, If Other than Above
Address
ir
GF
.` Permission is hereby granted to dispose of the human remai rib abg a 'ndicate
Date Issued ‘ --9— / 3 Registrar of Vital Statistics
(signature)
District Number 4-5D/ Place SARATOGA SPRINGS
i
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
It Date of Disposition b fill 0 Place of Disposition --+ CrevictOriUw
a (address)
i
W
CC (section) ot pumber) c (grave number)
Name of Sexton or Person in Charge of Pr mises iris (1w ei+
4
(pleas
Signature L Title CZ 19TOt
9
(over)
DOH-1555 (02/2004)