Dumas Sr, Robert NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Last Sex
Name First Middle male
Robert F. Dumas Sr- If Veteran of U.S. Armed Forces,
Date of Death Age WW II
July 3, 1999 71 War or Dates
Place of Death Hospital, Institution or
Town orI��e Easton Street Address 3239 Count Rt.. 7 4
Undetermined Pending
Manner of Death ❑Natural Cause Accident Homicide Suicide Circumstances Investigation
Title
Medical Certifier Names ,wc C6
r C Cr/ �
Address ,�.� �" �-� C h/
District Number egist r tuber
Death Certificate Filed 5753
Town orb Eas on
Date Cemetery or Crematory
❑Burial July 6, 1999 Pine View Crematory
Address® 4 y Cremation ueensbur , NY
Date Place Removed
F Removal and/or Held
2❑and/or Address
t'" Hold
U-5 Date Point of
❑Transportation �, Shipment
by Common Destination
Carrier
Date Cemetery Address
Disinterment
ddress
Reinterment
Date Cemetery A
Registration Number
Permit Issued to 00628
Name of Funeral Home Flynn Bros. , Inc.
Address
80 Main St. , Greenwich, NY
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 huma7(:ms�&ignats
described above as indicated.Date Issued Registrar of Vital StatisticsureXX
Place Town
District Number of Easton, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Place of Disposition /
(address)
W rave number)
(Asection) . Ao number)� (9
G Name of Sexto or Person in Charge of Premises
(please print)
> SignatureA Titles
VS-61
DOH-1555 (10/89) P. 1 of 2