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Baker, Arnold 1 NEW YORK STATE DEPARTMENT OF HEALTH Li Vital Records Section Burial - Transit Permit • Name First �r�n nl c\ (e Jr) Last f3a Y�r Sex N1 Date of Death 1 D 1 r.r I ao►3 3. If w or of U.S.Awned Forces. Ick 50_ q 5� c • : Hosp�l, lr ion or SO�`N,C.01 en.S Cr- MGreaca Street Address && Noun Roth \\5,AIy et Death. ►vt Natural Cause C3 ['Homicide ['Suicide 0 mined p circurnstar IMedical r on Certifier Name db eia- tit "Spun Title H D • Ctx)C€r Cena•ei- 102, Po,rK.S4 . (',1 en Vial's, AN I? ) . DeathTcCerfio�e Duct� �l02 1unber City. Village A'tsa ii-i-.[] Dame 1©Jle) 1S P v� Cc-em �oc as y - Moe Removed z 0 Removal Date and/or Held • and/or Address if!, Hold h Date Point of Ton Shipment by Comm n Destination • Carrier -- • ❑Disinterment �° e Addresscemetery Addre Revtterment DIde cernefery Address Permit Issued to — Registration Number Name of Funeral Home ' arrira ®- B3g k G ev r u.l K(r.,-e, 0 l 1 2 Address iI Ld yc St • iteenSbury kit. )2 (-DD . Name of Funeral Firm Making Disposition or to Mom 1.. Remains are Skipped.If Other than Above . • Addis Permission is hereby granted to dispose of the human dew above as wed. Date Issued J 011 S l I--3 Registrar of Vital Strgistics I Il • District Number 1456o Z P1ace,3.5/ RE)/N o L Ds aQ,. . 1—o2T E bu1 i9 ie_D / l aj • i• certify that the remains of the decedent identified above worn disposed of in accordance with this permit on: Date ofDthposthonlot2t lrN Placeof D'sposrtion ZiO4 v to rw.- n ( ) (section) (grave r><xrhber) -a Name of Sexton or Person in(charge of ��s ,. ".41 print) rr Signature L._.. Tie Car m _ (over)