Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Dodzian, Francisze V
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Biostatistics -Vital Records Section Name First Middle Last Sex Francisze V. Dodzian Male ::Date.of..Dea........................................................ :.................................. Death Age If Veteran of U.S.Armed Forces, 1990 > 80 War or DatesNo .......... Place of Death Hospital, Institution or t City,Town or Village 9............Cambri.dge.................... Street Address.. Mary McClellan Hospital f Cause of Death Cerebral Sontusion ::::::::::::::::......:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:::::::::::::::::::.:: Medical Certrfier Name Title ...........:::......::.::::::::......::::::JaY..:::Edison:::::::::::::::::,:::::::::::._:::::::::::::::::::::::::::::::::::::::::::MD..:....................................... ............................................................. Address .............................................................:::::::. Box24.1:5 Whitehall.,....NY...................................................................................... Death Certificate Filed District Number Register Number City,Town or Village Cambridge Date Cemetery or Crematory ❑Burial May 30 1990...-.._ Pine View Cremator ,Cremation Address QueensburY:. NY.::::::......... Z Date Place Removed O ❑ Removal and/or Held and/or Hold '::::::::::::::::::::::::::::::::::,:::::::.::::::::::::::.::::.::::::::::::::::::::::.:::::::......::::::::::::::::::::.::::::::::::::::::::::.:::::::..:::::::::::::::::::::::::::::::::::::::::::::.::::::::::::::::::::::::::::::::: Address a: > Date Point of 6; []Transportation by Shipment Common Carrier ..... ....... ...................................................................................................................................................................................:.... Destination .........................................::;::: :::::......... Dat ............................................... ................................................................................................ Disinterment a ': Cemetery Address ...........:<>::,Date:::::..................................................... ..................................................................................................... ................................................................................................ Reinterment Cemetery Address Permit Issued to i Registration Number Name of Funeral Firm M.B. Kilmer...Funeral...Home.................. 01.Q$F).............----- Adress ::..................::::::::::::::::.:::::::::::::::::::::. Main...St.,...Ar. le. ...NY...l $09.............................................................. ........................................................................................................... ..............................�Y............................................................................................................................................................................................................... Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above W Address Permission Is here4y granted to dispose of the human remains described above as indicated. €> Date Issued o Registrar of Vital Statistics &yam (signature) <> District Number J� 7� Place 6 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tr w Date of Disposition ' (Q Place of Disposition P!1t 2- U i` W L<X E/YI f4Ta l2 y NUJ (address) UJI. f]C (section) (lot number) (grave number) pii Name of Sexton or Person in Charge of Premises ' 1 C h 19 f<./ L-©1�C'� Z (please print) Signature Title C&or � r e rti 4 DOH- 1555(9/86)p 1 of 2(formerly VS-61)