Meinrenken, Barbara •
NEW YORK STATE DEPARTMENT OF HEALTH , e
Vital Records Section Burial - Transit Permit
Name First Middle . Last Spx
h_
Date of Death : Age ! If Veterarilot,U.SkArmed Forces,
i
1 '-o___ , at ! War or Dates RAD
Place of Death . I Hospital, Institution or
City. Town or Village Ft 31 A tru, ' Street Address
,414 Manner of Deathr0 0 Undetermined ri Pending
Natural Cause D Accident El Homicide El Suicide
e Circumstances 'Investigation
Medical Certifier Name
M •
P;1 Q1 if Addre s ,i /la
Death Certificate Filed D i District Number Register umber
4 Cit\rfoljyi)or Village
Date 6 1 )(:: 0 metery or Crem tory
0 Burial '
' Address
1:-1 2 Cremation i 4V1-latc 1 )i 1,xlchi
Date thce Removed
Z El Removal ! , and/or Held
0 t----i -
rt and/or Address
,rZ Hold
th
0 1 Date
Point of
O.r---1
0 L j Transportation !rn , Shipment
,
CI by Common ' Destination
Carrier
El Disinterment Date Cemetery Address
1 ,
,.
Cemetery Address
Reinterment i1 Date
Permit Issued to - ! Registration Number
Name of Funeral Home Address 0 OcD- //
' 1 ,f!LH Name of Funeral Firm Making Disposition or to Whom
S Remains are Shipped. If Other than Above
2 Address
4r,
It1 ,
11.7
Permission is hereby granted to dispose of the hum re ain deZed ab ve s indicated.
'!!1' Date Issued 6/7/eiaccc) Registrar of Vital Statisti s L ,,-3(7 1././..L._ ./-- ,Z;Z/V/0
111i: nature) /
,,,,:1: District District Number 3(4, 51.0 Place t7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I...
Date 5 Date of Disposition 4f:t Place of Disposition 12,J)4.co Crvh-etocivi,...
6ltl (address)
LLI ,
U)
CC (section) A(Jot number) (... (grave number)
0 Name of Sexton or Person in Charge of Premises t i,f Ili e' --)(6Irsit
-0
Z Signature (14k, - - (please print)
401. Title CKINPVCOC
DOH-1555 (10/89) p. 1 of 2 VS-61