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Kramberger, Frank E NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First �r :?Ie Last Sex .... L ..ti'4:h,..... . lam, _ , M Date of Death 2 / Age If Veteran of U.S.Armed Forces, E... ,J. /. / (� 7 4S War or Dates � ' .::. ........ .:... _ .. . Place of Death Z /�// ```` Hospital, Institution or W City T° Lwe.......�i ( �hS r—,e 115.... Street Address F'1 G�i Manner of Death:: __... . ©'Natural Cause Accident Homicide Suicide Undetermined Pending ........ Circumstances Investigation W Medical Certifier Name r1 Title ... .... ........ _.. G .. V �. GYY'��j �t I�f .. Address . Death Certificate Filed ,/' ff District Number_ Register Number City,Town or Village Date ❑ 3//� Ce �r Cre r'y Burial /...... .. . ..e ......w , r.c•� ���� ►. [B.Oremation Address . ....................................................... ... ......... Z Date Place Removed O ❑ Removal and/or Held 1-' and/or Hold ..:.:. ............................................................ Address 7 O ........ ......-.. CL Date Point of Ln []Transportation by Shipment p' Common Carrier Destination ... .::. .........:.......... El Disinterment Date Cemetery Address _ ....... . ._ _ ___ .-_. _ . ❑ Reinterment Date Cemetery Address Permit Issued to // y�( Registration Number Name of Funeral Firm �� 6( 'bl0'n Nth k.�j,p�, l 0 /��V L �( ��� ... . ........ Q J Address Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, if Other than Above ................................................_................. <ut Address s1> Permission is hereby granted to dispose of the hu n re ins ascribed ove as indicated. Date Issued Registrar of Vital Statistics( signature) e. District Number 4 Place I certify that the remains of the decedent identified above were disposed of in accordar e h this permit on: F- r Z Date of Disposition. Place of Disposition /�//1/.t�l/%.E"� C j�,E ",-01 /-6?/ LIA-) W 2>. (address) w 1= (section) (lot number) (grave number) pName of Sexton r Person i Charge of Prem'ses .Aff_ 4/X9/?j> W (Please pent) [ — Signature Title , ,�ScS/ DOH-1555 (10/89) p. 1 of 2 VS-61