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Lenhart, Brian NEW YORK STATE DEPARTMENT OF HEALTH - Vital Records Section Burial - Transit Permit <s Name First Middle Last Sex ,{3 R.,fit-1.4 -4 , J t Ifni-0,.1 1 i 4-Lc Date of D ath�, ' Age ! If Veteran of U.S. Armed Forces, >1}7 4/Ji! 1.=- 1 Uo ! War or Dates Place of Death Hospital, Institution or Z City, r Village Ail--1:--iiti yu, 8 Street Address <44 Manner of Death ©,Natural Cause _Accident E Homicide Suicide Undetermined C Pending — Circumstances Investigation Au Medical Certifier Name Title r Address iiitEi Death Certificate Filed ' District Number p (7 Register Number City, or Village IV SsZte-vfrt 3 / Sb I Date Cemetery or Crematory ❑Burial 141/91�0 i (IAtc V«' Address Cremation Q, 0 6CO:NS '/ I)4O • Date Place Removed Z — Removal and/or Held 2 —'and/or Address F- Hold > .Q _ Date Point of NTransportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address =<€s Permit Issued to I Registration Number a Name of Funeral Home 1-: b laevt2,a L.; c<c y 606 ' Address IE %CA� f\.-66. 1 ,i )J v k,E . f'•`f l'a2 c '> Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address • >1;L :a> Permission is hereby granted to dispose of the human remains esscribed a ve a indicated. 0. Date Issued '-1/` /i Registrar of Vital Statistics Latf- (I ' illi (signature) t District Number /55q Place /\,( o 1tir3n-,L , /I, t,( . (a I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: pr- E Date of Disposition 41•12.-13 Place of Disposition --oG* t�j +A4 ( or,_ 2 (address) III CC (section) (hot umber) (grave number) I 9 Name of Sexton or Person in Charge of Premises AI.}}r a� z /� L (please print) Signature G, Title CIWV144-7,-0Q, (over) DOH-1555 (9/98)