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Neumann, Johanna NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Sex ti ....... .. :..:.....:.:..........: .......... ... Date of Death Age If Veteran of U. me rces, War or Dates .::: ...:. . .. ii Place of Hospital Institutio or ..kU City Town or Village Street Addres3 ... ..:... .::: ...... .. Manner of Death N tural Cause Accident Homicide ui ide Un� erm' Pend::.' Circumstances Investigation L,3 .. _. M 'cal Cert'rfie Name '* it G . .. ............ ... Address . ...-.... , D ertifi a iled7 .../ Distn^umb r Register Num er City,Town 'r Village Date tery�-or Cre ory El Burial remation Ad :::....:.: :: ..... :.. . :: ................ Z D ce Removed 0,; ❑ Removal and/or Held F and/or Hold .....:.....:...................:.:.:.:.::.::......... .....:: :: ...::_ .:: ...::.:.:- .....::: Address 0..:...... ,. :. .............................................. .. . ...:. ........ ......... _........ . ....... ......... ........._. I.. Date Point of n' Transportation by Shipment p Common Carrier ..........,.. Destination ....... .......:.:..::...........:..:..::..:........::..........:. .: __......... Disinterment Date Cemetery Address ..:.... ............ ... _. ......... : ....... ...... ... ...... ........ ......... ........__. Reinterment Date CemeteryAddress Permit Issued to Registration Number Name of Funeral irm � .5v? ............... a � ' : . ..._. uf...... �1.? -" Address ©� - ....... :.. ... ..... .......... . N e ra irm a ing pos�n or to Whom Remains are Shipped, If Other than Above ... .. ...... ... . ..... ......._.... "tit ..............:.........:.........................:.......:......:...::............... _...: .:. Address 4 _....... _. ... .................... .......... Permission is hereby granted to dispose of the human emains es�fbed abo as indicated. Date Issued Registrar of Vital Statistics " (signature) District Numbers Place O 1 certify that the remains of the decedent identified above were disposed of in a dance with this permit on: W Date of Disposition Place of Disposition ���.tC/ (address)M ui s0 (section) (lot number) (grave number) W. pName of Sexton erson i harge of Premi s Z. (please print) W; Signature Title DOH-1555 (10/89) p. 1 of 2 — VS-61