Hanlon, Joseph NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
iiiiii Name First fiddle Last Sex
Date of Death Age If Veteran of U.S. Armed Forces,
S - - c=,C? i 2 "11 War or Dates
Place of Death H i
.. City,1Town r Village 1.,,Gjcc . �U-Lund Street Address \GAGA L(D�Q N V.
Manner of eath J Natural Cause Accident 0 Homicide Suicide Undetermined 0 Pending
Lt Circumstances Investigation
la Medical Certifier Name t Title
Aokel' CAI ! l a �. . MI .
Address Genr �aU5 . "I�
Death Certificate Filed District Number Register Number
Iin City, Town or Village �CLr _, Lv Z.Q Y Y\Q__. L E U
0 Burial Date C etery or Crematicity
ri nQ._VI Q.,\1,2, ,,..i4,-(2. .),\-oc y
❑Entombment Address /-�
Iiiii®Cremation Vvczsz- 1kkA Y N
Date Place Removed
Removal and/or Held
and/or Address
Hold
0 Date Point of
wai,El Transportation Shipment
a by Common Destination
iiig Carrier
Q Disinterment Date Cemetery Address
ligiiQ Reinterment Date Cemetery Address
« Permit Issued to Registration Number
Name of Funeral Home VAOYY1k_
Address i
•, C-1n Xx C-\( `j- . ?o )4 S up C yYI U 'CNC- \vI \-`bKk \--q
iil Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
r
It/
"' Permission is hereby granted to dispose of the human r ins described a ov as indicated.
IN Date Issued 5—b - 1 Registrar of Vital Statistics ( /�� ��, 1%
vA �. (signature)
;>; District Number 56 J vt Place LaA(.�. *V-U-a.V `
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
III Date of Disposition S J4 Jlg Place of Disposition ?A.-. �r:,i,„.✓
2 (address)
UI
VI
lr (section) A(lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises ,., 1+,✓"
(p ase print)
Signature 6 Title (Piemititit.
(over)
DOH-1555 (02/2004)