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Reason, Richard Alton 636 NERN)BU NGm WE CT'of NEll YORK-9EPARTMENT OF BERLIN AND MENTAL HYGIENE DEPARTMENT OF HEALTH OFFICE OF VIAL RECORDS AND MENTAL HYGIENE MEN 11.XM W'.01 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 158-20-063047 SENSE:(CHECK ONLY CAN) $OFPTX osPoxraxeous Tenwxnnox 0wouca0 rexxlxnnou -- F,.t DENY LGi BASE � SAY BIDS xAxE RWN AMR PHRASESST Mele 0.5 BS 2020 PLACEOF NDN YOPI(QtC REHAB w w Hmvxn w eenrxrwN ONSI EASHEM EVENTBEons James J. Peters VA Medical CARBIDE COMMENT wmvuvmwwwxeoexwumEnsuureEMETHOD OxeEaxvxr jj'VAA (I wM�LaM OEVb BMEu Nalu Oo lu e.0ILKANA]O REACTOR FOEc[x[ruvcnclawrarvµw msrAS,an cc., w+rvu arnrt DSP SERON N.x pinevie.Y Cramem Nxm Quenumburv. NY mox 05 15 2ND OFIRSAW HAVING GLEN FILED AS REQUIRES Ef GOVERNING THE PEDESTALED AND OBSPOSAT OF FRANK REMAINS HAVING BEEN COMPLED WITH, PEAMESION S HERESY REQUESTED ED HARBOR OF LEE EARNED AS MENTIFIED ABOVE FUNERAL minwswLx� Las NHRHA7a mn>Eam.0 ESTABLISHMENT John J. FDAFumnl Ebme. lm.(Bmm) 203 Emis1 S1 BEGAN NY ON97 APPLICANT mm Oes Rcemmett ovuewounmvxmn� .WHY.IAON/^ �1B 3N0 W PERMANENT 6 HEREBY GRANNED IN DISPOSE OF HIE ACTED HEADER.Hon E x NEI a mam VIRGIN NVAI or if it MR;ANN,DGGI 011 mmx reR ny Ma tlY Reg* I x SS I w 11 SKY Toi FEE PAID S 40.00 DATEJ�2E2O x L By ONDI . fy Public Health Law Sec. 4145(2b) 013823 Receipt Homan remains of _ _ delivered on 20_ Roe view teq Repmonz� funeral home ume on b�el penwt Cancel] Fun"Dcrct a Reg. oe Licence# r r'�1