Tubens, Edwin NEWYORKCITY THE CITY OF New YORK-DEPARTMENT OF HEALTH AND MENTAL HYGIENE 05C1
DEPARTMENT OF HEALTH DTTICE OF VITAL RECORDS
ANDMENTALHYGIENE PERMIT TO DISPOSE OF ORTRANSPORT HUMAN REMAINS
APV19.202011:OKPM 155-20-031178
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gSPOS N wr Plretiew CrmeWy DleareWry. New York 05 01 AGO
IML CEITTIFICATE OF DEATH HAVING BEEN HEALTH CWE AND AU LAWS REGULATORS
GOVERNING THE PREPARATION O dSPO6n OF now REM xG HAVING BEEN COMPLIED WITH. PERMISSION Is
HEREBY REQUESSED TO DISPOSE OF THE REMAINS AS BECTIFIED ABOVE
FUNERAL arcaruuexuLxrADDRESS CRYANI A Y STATIF
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NOTICE: TIGER permll la mat ERMISIINNmevB G theRANTED TOM V,Ri
of Health aM Menlal Xyglena;orODhas been mnede0, sR.
mlerReG or alverM In any mannt. if �rA00
vn 31 mEM_RURI FEE PAID$ b03 oATE W z5 /z= }RED Perry QruxAd By SENIOR Evem
Edwin Tubens
kharyler Hill Funeral HOlne
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ware Healm Lam see. aias<zs) 013783
Receipt
Human remains of Delivered can S�// , MAO
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