Traynor, Steven NEW YORK STATE DEPARTMENT OF HEALTH , # 5 2 1Vital Records Section Burial - Transit Permit
Na e, First Middle, ast • Sex
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Date of Death Age If Veteraffl of U.S. Armed Forces,
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Place of Death Hospital, Institutio or
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Manner of Death ®Naturaause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
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Circumstances Investigation
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Death Certificate File 1 �n �, J N
District Number Registe Number
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❑Burial Date C etery\of Crematory
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i':I Cremation � �l�l
Date J Place Removed
Z ri Removal and/or Held
.... and/or Address
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C? Date Point of
ti❑Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M ‘ L i, ( -140 , to ) 1 ?1
Address / _ 5 7 k ` ncl i cu, l )600-
Rool Name of Funeral Firm Making Disposition or to Whom )
Remains are Shipped, If Other than Above
• Address
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II` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 1OlO3 ZD(2 Registrar of Vital Statistics 6,6 _, 41,L, Atiiikev,
(signature)
Iii District Number c p Sc., Place oc, of Lo, La.ke
.:>.: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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iii Date of Disposition IMJlp ja_ Place of Disposition 47(..1Ul C nt,.r
2 (address)
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CC (section) A _(lot number) (grave number)
�aName of Sexton or Person in Charg f Premises o Lw
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Signature Title egibil I¢Ira_
(over)
DOH-1555 (02/2004)