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Oboyski, Paul NEW YORK STATE DEPARTMENT OF HEALTH * • (Oq3 Vital Records Section Burial - Transit Permit Na First Middle Last Sex . Date of Death Age If Vet an of U.S. Armed Forces, la- J Z 0 f L War or Dates ij,0 l Place of Death Hospital, Institution or Ci Town or VillageG 5 J l5 Street Address Gaier)s is tia) i-r- k .:Z Manner of Death Natural Cause Accident 0 Homicide Suicide Undetermi ed Pending __ �Circumstances Investigation MALIedical Certif' 'ram Na Title t; , �0 a C\tea n M� Address . _ L CL -rt'_V1`�bU(l KNI Death Certificate Filed 5 District Number Regis umber tom, Town or Village G s-� i t i jlp©l 5 Date Cpcnetery�(or Crematory ❑Burial _.1r1 - 7_- I _— ne V I e,L0 ( .'fir? l?rt/ Address J �Cremation l UkAkilSbu n. t . Date Place Removed 0❑Remov and/or al and/or Held = Address N Hold 2 ' Date Point of _ ri 0 Transportation Shipment fl by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to _ Registration Number Name of Funeral Home i, _i( -`jay i Inc, 00 -11 Address C 'k 5t is L►azernl; k g l a _____ Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains describ)d ab�ve sin ' ted. Date Issued /.2�O7/W/2-Registrar of Vital Statistics � �►u' (signature) District Number :5 )) Place Cr7444, /9A, AY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i- WDate of Disposition Ill ir;lit Place of Disposition -Reatu,) Cre,K,io r 2 (address) W N tr (section) (lot numper) (grave number) 0 Name of Sexton or Person in Charge of Premises lFied 4,sif f- (please print) y t Signature Title aim t}OiL DOH-1555 (10/89) p. 1 of 2 VS-61