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Rosenberger, Elfrieda . k NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Mid le Last Sex loll/>eda-- r' ,' s e4Z er g Date of Death Age If Veteran of U.S. Armed Forc46, 0,3 /3 /3 9� War or Dates _ }- Place of Death Hospital, Institution or A/f //�/ Z City, Town or i lage 6rai w 1 a((? Street Address� `1/!//'�c-/I'(a:cii�✓ h ha 6 Manner of Deat Natural Cause 0 Accident Homicide 0 Suicide Undetermined Pending in Circumstances Investigation fa Medical Certifier Name 0 fTitle /) O Asa/ '7 erry Akzrse a r` y Address /7 4 Isaw f* Death Certificate Filed 4,1 District Number Register umber City, Town or Village rirm eiI'ae 57 5 ❑Burial Date CerriAtery or Crematory ❑Entombment 0 ' ' �eiliea er'� 43y Address ;,,,Fremation 4 Ltutubccry/ , NILLO rd it Date Place Removed Z❑Removal and/or Held and/or Address t Hold to Date Point of lZ Transportation Shipment a by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home b1e.4/Q yjc�( Am g 2/I1C;. QQ, // Addr ss Iv S©k 5'oO /P uzern AI /d&'s/.6 Name of Funeral FirM Making Disposition or to W1 om . Remains are Shipped, If Other than Above • Address fr t il CL ` Permission is hereby ranted to dispose of the human remai descri abo as indicated. Nii Date Issued 03 /� Registrar of Vital Statistics (signature) District Number 7 6-- Place 3 ri`24fi f/ A I` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: k LEI Date of Disposition Place of Disposition a"' (address) ILEA U C (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises 2 (please print) 44 Signature Title (over) DOH-1555 (02/2004) Mar. 18. 2013 9: 10AM ti '� No. 2573 P. 1 /( 2_ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ```:,?_ Name First Middle Last Sex ,,t, g/frled�. ,&SenAe qer `(� t 1"..<<< Date of Death Age If Veteran of U.S.Armed orc , 03 i3 3 95- War or Dates } Place of Death Hospital,Institution or A A 5 City,Town or ,i age We Street Address_.!'tiKh' e Waal '✓hhith ' Qii Manner of Deat ❑ Undetermined Pending Natural Cause Accident Homicide Suicide Circumstances Investigation Ltf Medical Certifier Name Title q cs¢n 4ef Mae a)Qmor '`y Address /7 A `fir Death Certificate Filed District Number Registers lumber ` `> City,Town or Village c/dV/o li//e 57?5' 1 : 11 DBuri Date Ce tery or Crematory 03 703 /deviled (r�enteot1' ❑Entombment Adds • s remaAimir tion CQueevlsbury , 111414d t~A .:in, Date ` Place Removed Removal and/or Held and/or • Address Hold Date Point of ` I'; Transportation Shipment its by Common Destination Carrier Disinterment Date Cemetery Address qi El Reinterment Date - Cemetery address YR iiiiiiiii Permit Issued to be,a/gr Registration Number Name of Funeral Home Dle.�!/G( r, )Y ?1 me. 0',,,? 4, Add s _Y,, .D Aex ,c00 hde 1 uzernp 61 y /a 8V <3ii "'"' Name of Funeral Firni Making Disposition or to Whom , E Remains are Shipped, If Other than Above Z Address Permission is hereby ranted to dispose of the human remai deaeri ab as indicated. Dale Issued 03d''/ Registrar of Vital Statistics iii (signature) Mi 1 District Number ,Sot'5- Place riffle/6 I .Z. Li I certify that the remains of the decedent identified above were disposed of in accordance with this permit on; Date of Disposition3/9-f 3 Place of Disposition �, , e L/;/t,,✓ -�-�I` t1l (address) • (section) k-�r' (tot number) (grave number) ei Name of Sexton or era n in ge of Premises ` Kr,r� /✓ J. (please print) Signature Title /''1,9�rd2- )• — - (over) DOH-1555 (02/2004)