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Towers, Maxwell NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name Fir t Middlet S/e�{_ , �; axle// re'seiiers � �Date of eatAgIf Veteran of U.S. ed Forces, a.�OZ/ a26/3 77 War or Dates a/e ' I-. Place of eath / Hospital, Institution o 11,1 City, Town ills Grail t/j`l Street Address �Qi) ever Arci` 1497 . a Manner of Death El Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined Pending IliCircumstances Investigation tu Medical Certippr Na poke Tile o Sa, rrry N.{�. Address / 7 niad<s'►c Death Certificate Filede5rfr? 7 /ei District _1 Registe/:ber City, Town or Village ea ,5 , ❑Burial D03 /07 C %4 m cr.eod © d y ['EntombmentAddr ss Cremation ( aee.ei s ba f,V , v/ f a Se I l Date Place Removed O ❑Removal and/or Held and/or w;;; Address in Hold 0 Date Point of ft ❑Transportation Shipment G by Common Destination ffi Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Regi,Mation Number Name of Funeral Home 6 reamer Fl/)er2/ j' 32-- avail m. Address a e r04C iSt �� hie 01 e , /V& vy r k /a t, Name of Funeral Firm Making/Disposition or to Whom fii Remains are Shipped, If Other than Above Address Ir Ili Permission is hereb granted to dispose of the human rem "ns des " ed ab e as indicated. Date Issued Q Registrar of Vital Statistics j��j��J�, (signature) District Number 57A 3- Place— .��,��1-� Ny / '3 a I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: lit Date of Disposition Place of Disposition a (address) ILEA ta CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises (please print) LAIHmSignature Title (over) DOH-1555 (02/2004) 4 1C? NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit - Name First Middle Lt ' Sex Date of eat If Veteran of U.S.7' 'erc med Forces, _': 6-5— / �0%a7 A�.._ g*' li'!_ War or Dates Place of Heath/ Hospital, Institution o 1 City,Town a (�jgt1 t``�� Street Address jay, £f/er/I/ r �! Manner of Death 4 Natural Cause Accident Q Homicide Suicide Undetermined Pending Circumstances Investigation ill Medical Cert • r New 71,17P. uSSari erry r Ad ess >" Death Certificate Filed ^ District Numbe Register N ber : i,City, Town or Village ("� amv/II(�- 7� .2, ❑Burial Date Cwetery���9r Crematory ❑Entombment 05-,R3 cg �/i.4 vie/i'C't�4r v 7 Addr Date/ / Aj A Cremation Qteeits/actr /) Date / Place Removed Removal and/or Held ...` and/Hold or Address - , " i 0 Date Point of ti❑Transportation Shipment E by Common Destination Carrier Q Disinterment Date Cemetery Address iM: 1 Q Reinterment Date • Cemetery Address Permit Issued to /-� Regi tr tion Number Name of Funeral Home 8retheI F&,2.er� l>ema- ovail 1, Address yaeserg a Zak /uzerlie , 1Ve t v' i lc Ia W& Name of Funeral Firm Making/Disposition or to Whom Remains are Shipped, If Other than Above y2� Address _ - 'i: �,,� Permission is hereb granted to dispose of the human rem ns des ed ab e as indicated. ': Date Issued 0 ? /� Registrar of Vital Statistics � r/. It& (signature) District Number 5761)5 PlaceNA4?„-)r-Lfregte, 7 /02,93 a I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z �^ tti Date of Disposition S It�112 Place of Disposition �,., a.J C.,i.r4o r,_- 2 (address) W. (section) 4 ,(lot nurnberJ r (grave number) el Name of Sexton or Person in Charg of Premises Artyw ; ( ease print) tt€ Signature41,- Title Weifr OL (over) DOH-1555 (02/2004) vd ZZ£ZZb9819 ewoH ieaeund 5ui>{ elti:Ol• Z l £Z ANN