Nolte-Woods, Denise NEW YORK STATE DEPARTMENT OF HEALTH ' ` fill
Vital Records Section Burial - Transit Permit
Name First\ Middle /0 Last Sex
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Date of Death / Age If Veteran of U.S. Armed Forces/
Litt /i3 S-7 War or Dates
1—Ii Place of Death
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nstitution n r
City, rownCna / 96QtreetA qY
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0 Manner of Death 1 1 Natural Cause i 1 Accident i !Homicide ZSuicide Undetermined —Pending
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0 Cu cumstances Investigation
ui Medical Certifier Name iy Title
CI 9-9... ei445 s s/76
Address
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City. Town r Village So-,-) Fez,„ 5-7 ,,,;?
CiBurial . ate Cemetery or rematory
DEntombment; Address
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Cremation
Z r-1 Removal
a t i Date
y
, Place Removed
I! androl H:.±id F: and;or , Address
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0 Date Point of
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ici, i 1 1 ranspoi tadon _ Cop re
ES by Common Destination
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Cemetery Address
I Disinterment Date
Cemetery Address
— Reinterment Date
Permit Issued to - -. - ;
Registration Number
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Name of Funeral Home . :(,..c0 •‘ - --' , , ; • ! , , ' ; - - ‘, ; ,,,i,
Address ___ I -
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Name of Funeral Firm Making Disposition or to Whom
:1".'"! RE:I-nail-1S are Shipped, If Other thee Above
11 Address
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Permission is hereby granted to dispose of the nurnan remains gescribeg above as indicated.
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I Date Issued 1/-37--226/.3 Registrar of Vital Statistics
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1 District Number 5-To a Place -
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LJJ Date ot Disposition q-5--1"N Place of Disposition -4<s-A44‘) Cre-vv-ctont,,--
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Di Name of Sexton or Person in Charge oi Premises ///tr.yit191,‘,, Se v„-/ft
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ILLii Signature _ 7'0A0-- Title (eV PIVM(...
lover)
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