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Mitchell, Gloria
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau af Vital Records Name Flan mC Iasl PermW Num aused Uneol CerM1M Ig HVeMan AUSNnetl Fuim. raNSROID 71 Yap Worse Wks f Place of Dean Ib=Pies,mass ca W Cry,men ad Vilude, name musensors SrtMM w dress tKakl'vl fld,OlwmWY Tom, Nver Yvk 12de4 n Manre,d oaaN upralQnm ❑Atddem ❑lwmAide ❑wdx uneexdnimd [jPandinH cll'am s Imenigamen V MMiYQMkr Name Ruder Address mammonism, MO eemuury Teen,Nm YM 13914 Rath orifices,Flel Uislrkl Hdrur Pegsler Hum[er [A .Toxnaa Vill Questionnaire50.5] Rd ©Buda) UR Ceme¢ry,CremaNryor Fsil'Ty Name nEnmshnred p1YIDA PYU VYwGrtNery Demeanors e re Rtltlrerr dmnWryTwn=-IW Vp 13 Uvnmal z. � PenmaI om PWe Rmuad maor anegmxeM xold Mdaess �Trannom on oh Pointer4Common SM1ipH order NAa ❑unmermen One Qpcery Aderes= El Rumored Up (emeler/M3ms PermANsuNN Rgio summer rum,Nuer Name of rumored me modern U mor Round Hem Address 11 Laraetla 6L Qwm dry..Nam York 12804 Nam 0 Fureral Rmr Mating Iismirm orlo WMm f Pounds are Suipped.HgMr Our Akwe s Address a Ul Q. Pmmlaviwr In baMy pranged W dlapow of the human remalne darrlbed aboea u lndlcebd. see Issued dWllrzom NRjAa.ol Vilal Aallnirs f> .'t!i(fgvLWvkrf'EG' YJgndJ Atpmg Diner Number 56457 Elders common. Nm VM I serfy 1M1d1M1e remainsd and desse*n1 Nentmd surepre depend N in wort me Mln Nis Pemul on: One of Oiswsidm 6/12/2026hmd OhwsNm 21 IsuakerA. owe r=1 anA con 466 Q o M•.^dml pnrcnu M gName of Xdwl h din[M1algdfnmims Connie GoedeIt Z W signawre m�'O .G�I✓rtt..+ Tilde s OOx-zssslmhal Nldz J wntieHca1 Law see. ains(2e) 010393 Receipt Human remains of delivered on , 20 z <� "� ihefimW Mme oemeE Noiil Pemd� Rne view ceottq RepmaD offi,W Fumni Oieenory Ree.m Licuise Y Mitchell NAME ]6/12/2020 Gloria Mithcell Lai owner Gloria Mitchell Lm aMoricon 46BCurConcrete Oid:6/5/2020 Faund Hame'. Laker FH Cemeu Pine view