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Ferretti, Anthony NEW YORK STATE DEPARTMENT OF HEALTH U Vital Records Section e y Burial - Transit permit y Name First .Middle Last Sex Olt t7`N1 T��`itty V t,�,e.E777 Cid9L Date of Death Age If Veteran of U.S.Armed Forces, I�riy�d 4.3 7 If- War or Dates Place of Death .---- Hospital, Institution or City,Town or Village (y.�,,Qo�S '� Street Address 7245.it'44)EC" 417- `xEAt s iveds Manner of Death IKNatural Cause ❑Accident [l Homicide El Suicide Q Undetermined ❑Pending Circumstances Investigation 1 Medical Certifier Namee 44l Si 6"J1i f T r . Address /60Z , 'ee s T 6-f A-47 /.1 -c)/ t Death Certificate Filed / District Number a / Register�}� ber City,Town or Village E4i. /Ltf Y,� -. In Date or Crematory 6�r/ 2©� /odrvit e-,Qtr" 7/9-7z3,�iikti Cremation OC I a 44 4 e. ` `r'' 7 , WV Date Place Removed Q Removal and/or Held for Address iii Hold ' Date Point of 0 Transportation Shipment rei by Common Destination Carrier • Date Cemetery Address „ []Disinterment ~~ Date Cemetery Address -af Q Renterment `` Permit issued to ,.`- Registration Number <� Name of Funeral Home WiPe1 L)� A$ h C /y $ :��� Address ` ,t� 136 A),cz e e, 6/is its A•/ .7C O / M10Name of Funeral Firm Making Disposition or to Whom - 4 Remains are Shipped, If Other than Above _ Address La Til Permission is h y ranted to dispose of the human sins d 'bed as indi-- �<' Date Issued 1a Registrar of Vital Statistics J7 9 y, Al gri (signature) District Number S / Place 64 , f/ /4'/ /c SI j tr i„v. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 6111 1(3 Place of Disposition £ Cr-4fo _ (address) I (section) (tot number) (grave number) Name of Sexton or Person in Charge of Pr m i s e s t, } '�- 4.i�� acikkitse Print) P]i14. Signature 4 L Title t (over) DOH-1555 (02/2004)