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Washington Jr., Willis Cephus RX BetNTLM 05/11/mm 11 '.56 15164138355 P.001 May 11200E 42e McTurdC EvereN 15164136355 pA NEw YOR1(Lm CITY OF MEN YORK-DEPARTMENT OF HEALTH RNC AMENTAC HYREEME HEALTH DEPARTMENT OF HEALTM M'O MENTM HYGIENE PERMIT TO DISPOSE OF OB TRANSPORT HUMAN REMAINS AMa O..somas'.2e PM 15 20-021W _ EVER:(CHECK CNv p ) BOEATI OSPOMAMMSMRNMATIOX OXOVGF➢1ERNNATOX --��' NAME M u^ m �• . or WllC m WaEM1I JR. 5] Male 03 30 020 PLACEOF INVENT NINE NONE CIT Mwhatlan 555W1611161 �leA NTVYEAVNYI0332773.5 CFATIN ^^uimxw'wuenu,EvunEaavweAll I pxmxm 9MESP f„�n w"I. fAme Kra41 PmeMe Nnuurl mPOFu Gahm ll MA, AGESENO141 Swe VMS x Ec Plnav wALrem tors, neFrrvr Ouear , NY a O4 09 "I THE GETATIFFOATT M MATH HAVING SEEN HAD HIS AMSAM By THE HEALTH Seal ME ALL LAWS MAN REGLA-All GOVERRINS THE PREPARATION ARE MWGSAL OF HMAN REMAINS HAVING MEN COMPLEED Val PERMISSION 0 TT NY EBiAN'®IYEXT Ewre1R XE<VENLV Funeral NamE. lrc, IOBf PeCillt Sl Broo4n NY GONE Mu♦ APMICAXT HH MatlOrO C lanEre Everellxw mm 11095 xl VISA PERMI ION IS OF SIBICAMOVE MENCE: gIm�N�a MaeIVVNMiM1e Sea erm OePlrnanl9gm PEllpv-� �UE Seal E/i(AO Nanw ly9lax;..11 ll :m..xmueN, EA, Q/p¢91sV'+ MwNnworXmeem mrmwre,. w NlrMv.+xl FEE PAID QXO onTE�.��a o Mv-S41'dGE€ lal Public Health Law Sec. 4145(2b) 013820 Receipt Humus remains of U 'tf % _ deliverctl nn _, 20 w°�'li'nuory Representing he fwcml home Iametlon budnlpamit Dim FunemlDucuors Reg. ar LuznseX