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Giambrune, John NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Cif /,I to .840Ar 2 rt1 Date of Death Age If Veteran of U.S. Armed Forces, /-L —y9 7 z War or Dates _.S 1- S_Z ,v�oc/y Hospital, Institution or Place of Death HEN City, Town or Vi Street Address ��.S Manner of Death ©Natural Cause Accident Homicide ❑Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Address ,6 d e--`rv.tilt /1/J Qj Death Certificate Fil ,r -,,. District Num Register Number City, Town or Village 'L 1H L `� � t; Date Cemetery or Crematory ❑Burial Address Cremation cei bur !u Date ace Removedf ZRemoval and/or Held .•• and/or Address Hold Q Date Point of NQ Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinierment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home _ i�J -} �tila•a+ • 1 w d� 70 Address O C. t'o.c t4 L-4•c, s S:4 TiG3 ✓ ,�s .0 C (� Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remailescbed �ove as indicated. Date Issued //—e6-V!2 Registrar of Vital Statistics (Si'OENEC (') 7 Place TADY District Number _ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f z Date of Disposition -� �� Place of Disposition y.lJ to f� �- 1 + (address) UJ (section) (lot number) (grave number) FName of Sexton or Person in Charge of Pre ises G 2- G R�ft W (pleasTpletCQ c-1 j4 IV(� Signature � t' DOH-1555 (10/89) p. 1 of 2 VS-61