Spinazzola, Vincent T NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics-Vital Records Section
_ Fffst Middle 1-ast x
leeteran
I"Date ofDeath Age ? of U.S.Armed Forces,
War or Dates
ace of
Pl Death�.' � Hospital, Institution or ,C hewn or WHege ,; Street Address
Cause of Death
A: Medical Cert'rfibr Name Ttt e
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Address ..:...........,.......:....,»..::.»,-.:.»............................ ,..:,.,:.....,.,.,..,,......,.....,...,.........,.:........................................,.,...
ath Certificate Fi District Register Number ,
(AT-awn or Village ��fJ
Date❑ tory
(Cemetery B �F, •a
uriale f
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RCrematicn ; Address
sZ ? Date Place R moved
0 ❑ Removal ; and/or Held
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!Z; ' Date Point o
O: ❑Transportation by Shipment
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Destination
171 Disinterment
Date ?LACemetery Address
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ate ; Cemetery Address
Reinterment '
Permit Issued to Registration Number
Name of Funeral F'irm
Address
,J
� N Name of Funeral Firm Making Disposition or to'hom
Remains are Shipped, If Other than Above
Address
..........................................
{{v, Permission Is hereby granted to dispose of the human ram sins described above as Indicated.
Date Issued Registrar of Vital Statistics
(Sigma)
District Number �1 / Place 11`Z 2i2
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition �3 Place of Disposition �/N��//,F� 4: &0yJ9 ZEAP1 C/A)
(address)
(section) (lot number) (grave number)
o<fl Charge Name of Sexton Person i Char a of Premises
z (please Imo)
Signature Title
j
DOH-1555(9/86)p 1 of 2(formerly VS-61)