McGuire, Winifred NEW YORK STATE DEPARTMENT OF HEALTH r % ft 7-3
Vital Records Section Burial - Transit Permit
Name First Middle t Sex
1,� 1 n►ire d K K .
Hec--iu,ire,
Date of Death Age If Veteran of U.S.Armed Forces, p______
1 ' f I a /O 1 War or Dates
2 Place of Death s �) c V � (� a bo tN e `I rn Ourvi I K&ii h 3.c 1 k U
a_ Manner of Death �4 Natural Cause Q Accident ❑Homicide 0 Suicide Q Undetermined ❑Pending
Circumstances Investigation
' Medical Certifier Name Title
, �er,�ccr-cty �I lam,j�tc.r� M0
Address y i Ea.S-f` Si .� F . EC/WO/lc c i � 0�(9V
` Death Certificate Filed Distrist Number Register Number
eity overt r-Ville e— k.3/W Dj IOUJ ` —(9 _ �p
]Suriat Dateisct IQ remato n
r inc., N '( v C ernes--b'-
❑Entombment Address �pp�� �
remation a L " i / Cit,X. r t�s
Date Place Removed
Removal and/or Held
C . and/or Address
Hold
la Date Point of
El Transportation Shipment
t' by Common Destination
Carrier
Disinterment Date Cemetery Address
Reintermen# Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home lAniraia). f2ya Kt r Fufe rct.‘ [iorr(L. 0110,
Address
11 Lai-aye iie c -ee- , ic;ickeensbur Y, 1\te yor1L 1 Z tot-i
Name of t= rm Makin Disposition or to Whom
Remains are ShippeduneralFi , If Otherg than Above
S. Address
$` Permission is hereby granted to dispose of the human remains described ab s indicated.
Date Issued f _ (ct_ Registrar of Vital Statistics -� — ,
(signature)
District Numbe
E( , ) Place J O u._,C) --( 5 s
6411
I certify that the remains of the decedent identified above were disposed of in accor. 'th this permit on:
Mil Date of Disposition I /121 r2 Place of Disposition -YiH({c1J jiff&CICAWes
( )
of
to
ir (section) (lot number) c (grave number)
' Name of Sexton or Pers n in Charge of remises 4,371-/Or J Mil1-
z41) (please print)
Signature14, Title ae iro A}.d(L
(over)
DOH-t 555 (02/2004)