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Grube, Anna M.
r 7n NEWYORK STATE DEPARTMENT OF Harris ' Burial - Transit Permit Bureau M vial Records Name Cut wtlale Ian xx Arm M. GnM that, care of Death Age If ve@ran M Uak Armed Forte; e.xemrs W"OrDsaee Parent Came Ibrpilallnsdrutimd [iry.Town o,vilage QuesmacrunlTmn xreel Address Warm Cenm Mr PnnnGi who Nurwar of Manner W RR: ©Natural cause ❑Auidem ❑Ibmk* ❑Suiriae E] Undea:mirca �Rnaing Dw.meana, mremIs w Metlmalimm Fier Name The O Roelm Scslul NO Morass Q What0.WexsLurY Towm.New vpk 12504 Death Cenairne ilea Oinrin xumeer near us Cmulrow,wrillmadr, tMeneWry in El Rural Cure [emnerY.[remnorvorFsifdY xme ❑Enbmbmem M95,20 Pine viwertmalwy Address OCremNon ggenalurs Toes, sew YaM Darrican ❑summer Cme PretaxAenmetl andkr andbrxela Al �Tra Dark Polmm .cewwn s m end bv[ommon Camer Dhastra n �Cisinerment Fore Cemehry Address �winremem Cure Ctmeary Ald mas Permit Issued to Reliatmun Number N.meuf TO....[Home R'awar wnery lbme Me Wzff "Bass 21 CnuM 9nr1 PO Pot 5W,LeFe Wxeme, New YaM f28e9 Name of Funeral Firm Making rd Whom I_ Petri..arew a.nUAerNen Rlove Address w u Rarmlaelan Is M1aMy9ranlatlbtllapaes of Na human runelna EexAbatl *be" uintlicegaa. Our,I....d ` Argument Vital Sulinks Caroline HllMaMl SaW EIRVonialN SiACe01 Nrowral oiSre Number RAW NMI ganmeawk rywYaM emp that the remain.W tM dNM,m memA'ea aM,er were di,p,,d din xroN.ze rMn our Pushed on: W Murmur Oigmdan /�/w.aLzn PlacedDlsurstiOn f w DO i fw m.wN1ar Fm.ae+n gNameuf SMAmOrRraonm mi au . a .J E Yba i f oM�ww w samovar r A rid, DOH-655lmDal Ptd2 wwic Hwm �w sec. 4145t2n> 013904 Receipt Homan remains of delivered on (cIS M20 a� Noe Y[w Cemetery eting ft fuIX home=qptunApn®t O15[iel NmeN Di2[Ime Re6.mLiceoeeH HInCAI