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Greco, Pamela or NEW YORK STATE DEPARTMENT OF HEALT. Vital Records Section Burial - Transit Permit Name First Mid Ie Last Se 1 e % ' /i 66r�eco MZ6 Date o Deat � / Age6 If Veteran of U.S. Armed Forces, War or Dates 1— /Pyltc-al of eath Hospital, Institution or 1 .� C. own or Village a/g,t —A-7/.� Street Address 60 / ./� -0�`�' tLi p Manner of Death r'Natural Cause Accident ❑Homicide 0 Suicide 0 Undetermined ri Pending 1U Circumstances Investigation tu Medical Certifier Name /j Tit ��i gv ,/ - /yr CI •i • .::.. )2,3 ,s, 7d)7,__. (..,/z_e_r/e, ,72,,,,,...,,,„"7 ....„,(7,9,/,4"./...,7 Dea h Certificate Filed Register Number City, Town or Village e /l�/7/( District Number 5 !'0 l 5% ❑Burial Date cry or Cremato ❑Entombment /�/� ��� r e 1�-P �(� i �/ 1 Address A /C� �/ Vremation mi_e_.€_,07 ‘/v / /)-(1 5/ Date ace Removed Z FiRemoval and/or Held 1 I—land/or �,� Address t Hold 0 Date Point of Q Transportation Shipment G by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to C% /� � Registrationj mber — Name of Funeral Hom C / /j1�C' jri�/�I�c• G9©/�%7 Address 4,7/7.& ‘/ • eAeLC-7L-er&t/ ,/( Y/i2--e' // --- Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped, If Other than Above • Address t: 97 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued jL-////ZO/e Registrar of Vital Statistics w QA-i y"-0 �'f (signature) District Number560 i Place 6 (c, - F t\ S . N, y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z trig Date of Disposition I .-ll-1 Place of Disposition 'p;f1Q, V;Ijo) Cr-co cc (address) Ili CC (section) (lot number) (grave number) 0 Cr Name of Sexton or Person in Charge of Premises Tif»iv S .vTtc Z (please print) • Si e gnature Title Crt,mciiof (over) DOH-1555 (02/2004)