Meister, Margaret r • c3Z
NEW YORK STATE DEPARTMENT OF HEALTH Burial _ Transit Permit
Vital Records Section
Name First Middle Last Sex
0 rG( .tea, _ 1vV.i5-k-i- - Females
Date of Dea±A Age If Veteran of U.S. Armed Forces,
-5 -20(3 g3 War or Dates Kb
'C Place of Death ; Hospital, Institution or
own A City( r Village SiDn C� Street Address ICI S
Pri
Manner of Death Natural Ouse Accident [�Homicide Suicide Undetermined Pending
Circumstances Investigation
iljMedical Certifier Name l Title
0 Jocph M► Ri nd u iZ.-
„Address
C) L ls ti y -
Death Certificate Filed District Number ' Register Number
City, ow r Village rtr Cre2J( ! 50.54R
Date metery-ol Crematory
CDBurial P UI 0 5 / 2 013
Addres
LJ Cremations toe- Sb t Ai Date /Place Removed
}❑Removal and/or Held
= and/or Address
Hold
G ; Date Point of
wQ Transportation . Shipment
a by Common Destination
Carrier
0 Disinterment ; Date Cemetery Address
Reinterment I Date ; Cemetery Address
Permit Issued to p ' I Re istration Number
, `- Name of Funeral Home l C A YC.tr �all ni f ►�Q e, I t�[. O 1 I
Address
tc -ef- eilurch st __._LQ..RL.._.J_ik›.._.r--,ru Ny )28+4, _
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped. If Other than Above
itg Address
ilk __
Permission is hereby granted to dispose of the hu n e ins describ bove icated.
Date Issued 9-5-2_0�3 Registrar of Vital Statistn ..A.
(signature)
sDistrict Number 5 625/2 Place To L�YI D h �—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Ir.',
W Date of Disposition 1113113 Place of Disposition -ri0140 C or%--
2 (address)
W
Cl) (section) -(lot number) (grave number)
Q Name of Sexton or Person i Charge of,Premises 4,risi,.... sf k,tu
Z �
(please print)
U.! L'
Signature Title CIiAMIL
DOH-1555 (10/89) p. 1 of 2 VS-61