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Doescher, Julia NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Julia Doescher female Date of Death Age If Veteran of U.S. Armed Forces, January 25, 1994 95 War or Dates Place of Death Hospital, Institution or (&r4KXM aWillage Cambridge Street Address Mary McClellan Hospital Manner of Death©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title David S. Jackson MD Address Cambridge, NY Death Certificate Filed District Number Register Number Qi cX=Xor Village Cambridge 5721 Date Cemetery or Crematory ❑Burial January 28, 1994 Pine View Crematory Address ©Cremation Queensbury, NY Date Place Removed 8❑Removal and/or Held ••. and/or Address Hold Q Date Point of Q Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Flynn Bros. , Inc. 00662 Address 80 Main St. , Greenwich, NY 12834 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 remains described above as indicated. Date Issued 1 /2 6/9 4 Registrar of Vital Statistics ,, .tit�2p � Q s (signature) District Number i Place I certify that the remains of the decedent identified above ere disposed fin accordance with this permit on: Date of Disposition,, 1Z � 4 Place of Disposition W. ii✓ ,.l�.0 G 1� 9. �'y f� !I (address) LLN (sction) (lot umber) (grave number) 0 Name of Sexton or Person i .Charge of Prrmises / (pleas T print) Signature DOH-1555 (10/89) p. 1 of 2 VS-61