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Chappel, Sherman NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Sherman �lffon Cho P- /�lczl Date of Death Age If Veteran of U.S. Armed Forces, A/0 V er»be r aM 1997 ,641 V r-s' . War or Dates wo Place of Death Hospital, Institution or City, Town or Village 76wl) o-41 7e`con c%r Street Address 76 ZCL1 d Lora RQCLd Manner of Death DiNatural Cause 0 Accident R Homicide Suicide Undetermined OPending Circumstances Investigation Medical Certifier Name Title /V!. 2 1 Q 02 C -I)L-- dress Death Certificate Filed District Number ,/ Register Number s City, Town or Village Town o-F T/condero /�6 T Date Q Cemetery or Crematory ❑Burial Al vem her- J 997 P/ne- vi' r(?/»cz f©o' Address Cremation ue.e nS' 6 u N Neu-) / O) Date Place Removed ZRemoval and/or Held 0 and/or Address Hold Date Point of IR N ❑Transportation FShipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home I Ieo ke ar) PanercL/ Aomc Q Q Address > 3f ands S Ticnn pro Cz y. Ia '£r3 Name of Fuh4ral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Pe.rnissicr:s hereby granted to dispose of the burns r? jnainsAescribed ove s indicated. Date Issued 7/97 Registrar of Vital Statistics (signature) District Number Place TU Ti CU I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition� Place of Disposition (address) Uj (section) (lot n mb r ���// (grave number) GName of Sexton or Person in C arge of Premises Qb ,A �T 4 F (please print) rr W- Signature Title © / r DOH-1555 (10/89) p. 1 of 2 VS-61