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Findholt, Elwood 1s / NEW YORK STATE DEPARTMENT OF HEALTt3 j,, Vital Records Section Burial - Transit Permit 1 Name First Middle Last Sex } Elwood R. Findholt Male Date of Death Age If Veteran of U.S. Armed Forces, 03/18/2013 83 War or Dates World War II 1 Place of Death Hospital, Institution or C/C'/kai, n2 T4-%- Z wr City, Town or Village Chester/top. Street Address Deceased's Residence W Manner of Death 0 Natural Cause 0 Accident Homicide Suicide El Undetermined Pending Circumstances Investigation W i Medical Certifier Name Title C) WILLIAM C. ORLUK, Address 6223 State Rte 9 Chestertown, NY 12817 Death Certificate Filed 0 JJ � 1 District Number Register Number City,Town or Village 1. h.ef 1.-e 1 ❑Burial Date C etery Crer(iate` 03/20/2013 r/ V(y�/(1 `417l�l /04 II iA4 ❑Entombment Address kA ®Cremation ( tJJ n ---e,e.x 7 7 / ©2/ Date Place Removed z ri Removal and/or Held and/or Address E Hold N Date Point of aEil Transportation Shipment #A by Common Destination 0 Carrier Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141 Address 9 Pine St/P.O. Box 455 Chestertown NY 12817 • Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address CC 11" Permission is hereby ranted to dispose of the human re :ins d_e-c e ove s indicated. Date Issued ,. all / Registrar of Vital Statistics /� • % y " (signature) District Number S(o a Place 2Lu-/L 1///'' I certify that the remains of the decedent identified above were disposed of in accordancewith this permit on: w Date of DispositionZ&•1.3 Place of Disposition ,,+,,4_ kit cc() 11€# ,m i*s.y 2 (address) W CO W► (section) f ot number) (grave number) O Name of Sexto or on in harge of Premises S 1 ��,... �'�`' cd © n/� '�,�, (please print) jA,, W Signature Title l eie,4 /,tviai� I �. (over) DOH-1555(02/2004)