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Dwyer, Stefania S NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Mid a Last S ...:::.:. ,:..::;..: ...::. : _......... ........ _.. .. .. ......4d/ Date of Death ge If Veteran of A Forces. War or Dal Z Place of Dea Hospital Institution or City Town or Village Street Address o Manner of Death::.:. .Nat ,,r.. :: _ Undetermined:. -. Pending Natural Cause Accident Homicide ❑ Suicide ... _:.....:. Circumstances Investigation W Med al Cert Name Title lam/:. ..,�. ... .. . © j A ress Death Ce rfi Filed Di ct Num er Register Numb City,Town or Village j 3 a D Ce ry,,or Crem for Y ❑Burial Ad...:.: :: ._7-j. ::::..... ..... ................................. u . remation Z ate ce he o O', EIRemoval and/or H F- and/or Hold ....... ............................................. :::::::. _:. Address O........................ _ .......:. ............. a Date Point of chi Transportation by: Shipment p Common Carrier ...............................::.................. :. ........ Destination __ _ _ __ Disinterment Da te Cemetery Address ......... :. .. _....: Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Firm n Addres....... ..... :. n .J. � ��� 11.. 3 .,,,,:.::: ...... ..... . : Ar " ........ ? _ _..... _.. �-; I�farfie unera g Dispo ion or t tom � g< Remains are Shipped, If Other than Above ... ...::....:::.......... ..::...:. ... . _::..::...... .. :--.. ........._.. WAddress . -..... . : .... ....... -.... .... ... .... _ :.:::::..... -:. Permission is hereby granted to dispose of the hum re=t; ri ed abo a as indicated. �--- Date Issued Registrar of Vital Statistics ature) District NumberAq Place I certify that the remains of the decedent identified above were disposed of in;a , ance with this permit on: ZI Date of Disposition Place of Disposition .� ,F 2' (address) W' tn' (section) (lot number) (grave number) p Name of Sexton r Person i har a of PreDvises Z' (please print) ut Signature Title DOH-1555 (10/89) p. 1 of 2 VS-61