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Gregory, Anthony 4 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section ?: Name First Middle Last Sex ;:. .. <: Anthon Robert Gregory..: Y......................... :...A a If Veteran of U U.S. Armed Forces Date of Death 9 September 20, 1999 .... ................... .... .. ...... .: _.............:.:.:.:.: 48 War or Dates t . .. ~ Place of Death Hospital Ins i ution or City,Town or Village Syracuse Street Address Univers i t Hospital C ,:..:... ndetermmed � Pending Manner of Death ® Natural Cause Accident Homicide Suicide Circumstance Investigation W ..... .. .. ..::. :.... Title W Medical Certifier Name Hussain Khawaja ................................ ............ © ............. .............:......Address...:..........:..................... .. .......-:....... 750 East Adams Street, Syracuse, NY 13010 D .:........: istrict Number Registe r Number Death Certificate Filed City,Town or Village 3300 Date Cemetery or Crematory ❑Burial September 27, 1999 Pine View Crerr�.toriun ................... ... :.. . ... ....... .. ®Cremation : Address Town of Queensbury, N1' ... ..: ... ... .. .... .:. ........ . .. ...- :.:.. .:: :.. :.....: .:: -::.... .:: ::: ::... Place Remove Z Date O, Removal and/or Held _ ...... F- and/or Ho Address ......... ......... OL Date.....: Point of N Transportation by Shipment ............ p, Common Carrier ............. ....:....:........:....: .. : ::..:. . Destination .............................................. ......:.............:...:. .:.......::.. . ..:... - .............. [ Cemetery Address Date 13 Disinterment ................... _.:. . .:.:. . :::. ... Date Cemetery Address 13 Reinterment Registration Number Permit Issued to Name of Funeral Firm Carleton Funeral Home, Inc QQ297... . ... .... ............. d ess uAe Box 67, 68 Main Street, Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above ........ .: ............ ........ ...................:,....::......................................... .... ul: Address ......:.... . ...... . ....... . ....... a ............................ :.::: ... . Permission is^^hereby granted to dispose of the human remains described above as indicated. Date Issued Registrar of Vital Statistic ( i nature) District Number 3300 Place COUNTY OF ONONDAGA I certify that the remains of the decedent identified above wpr disposed ofof`n accordance /with htthis permit on: Z' Date of Dis sition Place of Disposition r� W M (address) 2I'. M'I (section) /���J/J^/� (lot number) (grave (grave number) pIA. / ! ,// / / y l Name of Sexto r Person in harge of Premi s Z ( lease print) , t W Signature Title VS-61 DOH-1555 (10/89) p. 1 of 2