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Wolf, David a.. Funeral Director: 1`I L ^0 T-- , /''%D IF 4-4 Name of Deceased: -Di4 ) U 'l) U Case Number: 2 Z- Z- Date of Cremation: S- "L5 Retort: J.V,Ti Time Cremation Started: 1 1 U kL}-A^ - Time Cremation Completed: Type of Container: r,A VZ- liXwl,I i-d AA Nt I Remarks: 2. CGwbt�t- ¢i 10 1v L4.) All, 1 I I ' I I I May 23 05 06s16p Jennifer Scholl 941 -355-5376 p. 1 05/23/2005 05:55 1518494294E WTON MCDERMOTT FHN PAGE 02 not"/�*Wb 17:29 516--696--2743 I Wk" FZFERAL PAGE 01 too- Town of Quemm" Pine Mew cenre.ry a crw nmbrimn Owher RoW,Ouwarm", Now Yom 12904 wwo(516)cmrAk km 74646T7(a no an"W) Ounwbryr 7,6./A76 AUTHORIIATION TO CREMATE Tn.WdOMto"RHMM and 6WftrsM►1M Vlw.Crargala k^,in s000rOanwaom snd a"" b Mt► ane Rs-MM11M P b Crmns""nmalm u��NOE ak.r tsNy soft xIP pim Ada.n Natnw and wddte of nsusd llvkv reww"or name of parson aulNorlsing Cmnown �i .3e/� at* �s&t'. ,,le Ci.6Q1sod74 1_ y.**/j Q_ ra�,hj r Rwlwtlarlrfllp m daasawatl Nwnr at Fl,snral Fivrrtw ��i !� d UPOWAINT t tgrwnYptMd/��..tdhy wa�dw�Mtn ars..N�erlfM.Ols�t+ta7tNN�tttra lnr badly tCwld.!ONE) t aw*sw t tt=NN Paw aid wAhw+>.stw to w-tga ror++.awtMton a�,.�trwttl arse a dNrol M�rtlst al M OtMfwtwl/�IldiAd.rtw�Oaraattw/wroatar IM a1Nti/Oaart tantwad ar fMy�attttttgwl at+0�� to M4wk.a>�r awd aM tntttat■�VM vtNw C�b1►w�Mom an}'rd�onrtn and awis'/�tar rNs ar dawr�o.dw+► t>/t>• •ft� ►-Pena ar ur awwwdo 180 Ww WWWWR Its"Ow"Wm w&$$ ."6*=ad, ara nitOily wta dWm ft*o Nr Aa tM 3491 + �, � Aefdresa (810)dATURF OF RELATIVE OR LEGAL REPRESENTMVE) atpnwe ae l�Ma Oww �`a.��rJ S