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2012- Transcript
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section I \j ~,} CtlJ ,) C)) l 'TL~+--H [L:,~' (r) 1'---' --, ," ......12-- C U Local Forms Disposition Report ..... <u ~i ........ :> c .~. . rrhd,5~~fYe$ri '"' ,111<< Initials........ ........ IU::> J -~r 1'Z 1-'-1"6 '.Y' I .:... 1 '?JCt f) Ltllf1 q (nHk'ut(ll~).3'>/h Ih r{'v L...J q I- i - IJ '12 ,-Li ''i . 2- l 1 ":;J.' .5' W IY Hh2-~ I. CA..q u.....l rflll~~1 ,~ 2'::20 JU LL/ 'II' d-I .,J I - I \- It Z~l ! 'dJiJ.:tJ II ~J~02 IY)r~QDi 1-)('" 'i '-\lltl(j.:V~~' j _ltj-1'2 LL-I'jJ.\ / 5CCb' ~11 '-bq-l l ZZ:::;'Z I I ,,)-u-O L L I <(L I / /~<"J ti I 2L3'~ ( --....... 1- ()--:~ c,} L Lj"'" L I J ? '3 LIICj'Lll l i..' 2t::=:)q JlL, )-;)3-1:3 <-.L J <t;JI I -)'U,'ij \, J; ) 2c:, S i._; J' , J. 'y-,p ,-L/'-t:",}'l } ~)U' f: l (t'1~8' ( :). ( )U--l5~ i, t ,I'" I f t DOH-2896 (7/2000) , 1'\ )l-2tI,2\~J f-tC5 t ") ("'- ". 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Lh~~~ o /~~ (fi f<:;- 1, ~ 7?f r ... ) /..-.5.0' (~ '')<0/ ~~ /1 t::/'5I'J.. &j~: /"JPf~ 71~q3 7/11J <J l) L~'4 T1 ~ ~'O\ L-~~ '7 UJ () ~ LhJjt 171 (CJ l/ ~~ t~~ rl l/~ ./ V) '-!j?J.'j . I II A '-- P<- , ""1{'-f; l} I/{, 4~ L~4 I I /hJ l-501'10. \..~ I ~h~ LYJ/ J.fCf). L5~:t -1/ a~ eLf LZo;~ -f Id~ @ L3~j r;/ P-J i I!r- L~~f7 'i!5i ~ L~3 H B/o/ ~~~ -'lff~ ~/OJ @ L~/hi-{ /b/EA ~~ L5~'7 ;:; Irl ~ 1/ I ,()/ y..J::J Jr'"l llL I~ ~)t?) (~~ ~;~~'f (~ It ~ ~ J-/14 RIJL! I~ Lf$jf DOH-2~96 (7/g::; NOi(j...<<)) I.... ............... ............... <<....1</ .......,i\"z) .....i ..... yes)) ....... 1< 22.Z< ............. /~bX :ud , J !J,C? 7" 1,?()7&'b I ~0?<; , ~ d6Dot I .1 I S&Y: _yx/C I ~bV' .Z)Cf5$ I Yl(;19 t::r'RC::> <l '-' '~0s;( ,y'jfJ{-: i ~C9; L.J J (),-I) I r1j;~ Z; I / (~t: I ~l)( ,;fI(6 l'2.h~ <;/'1/5 J 'v ~ . (?JUg J 'V~ S/d/f)d J 3c,x /.0./,];. xc ")(( ......... /3tflf' f5J~gq /j0f- 6J3SL1 ,~~~ 5/4/Q- J ~ ?~9: 5J 46JJ. J 12., C,y I Il~(~ g 5 J (#(1() I '2,6>r ~HIca'~I ~1G~ ~ ~~,~i'~C./u ~ f 5- Z~~Z ° Local Forms Disposition Report NEW YORK STATE DEPARTMENT OF HEALTH D to Er7->~loy~~'~ Ir~iti~ls Press»# Vbtd (check if Yes) Local Rer ister# Receapi x Comr~~nts s ~ - ~ ~! ~ zs o ~ ~ ~~OI ~f ~ ~ Sao 1 3 ~r ~.~~ ` 6 ~f ~~ ° ~ .~ ~ ~-, '~ /3 ~ ~ - /~-~ ~/ L50! L,~ ~ ~_ L5v~4 ~ 5 of ~~~~ ~ ~ ~ ~ l ~ ~~ ~ ~~ ~ ~°~`' 13~~ X501 y~ ~ '/ U lO LSGf ~~~ - to ~01 ; GSC~y ~ . C~ l~/ L 1- ~o c~viy ~ ~ r"10 ~ 1 ~l.p~ ~-~t DOH-2896 (7/20C~v 2~ ~ 2 NEW YORK STATE DEPARTMENT OF HEALTH Local Forms Disposition Report Vital Records Section '' Deg#e Employee's idl i Preas# Voit~ ;check ii Yes Locall2e< isterrt ~ FZecei{~t # Cort~r~aents It~f --~I2- r~it s ~~ 50 ~ y 2 . ~ ~ L.~t~ ~ COQ Z 1 v ~fl1~61~ ~~~~ ~ `~~~~ ! l ~S a ~~~ - ~ ~l ~c~ ~ ~~c~ 1 ~~c~o~l ~.~~ ~s Lam! $. ~~ i ~ ~ ~ 3 o ~~ ~ ~ ~~ ~ 1 ~ O~ t L~ s ~~ ~ ~ ~o ~~~ 1 ~ ~ 5~~1 ~" L ~ - ~~ ~o -~ ~ r /~ 1 c- 1 1 ~ 1~ ~ ~ ~.5 ~-~ ~ ~ a 7l ~ L DOH-2896 (7/2000) NEW YORK STATE DEPARTMENT OF HEALTH Local Forms Disposition Report Vital Records Section Er~,ployee's Void Local Re ister# Receiy~t # Cumir~errfs Date Initials Press # ' check if YES 9 DOH-2896 (7/2000) . ~.- _ ~~ ~(~L~Y-~C~ 2~~ LZ NEW YORK STATE DEPARTMENT OF HEALTH Local Forms Disposition Report Vital Records Section DOH-2896 (7/2000)