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Benton, Diane NEW YORK STATE DEPARTMENT OF HEALTH Vital Records seebat �; Burial - Transit Permit Name Flat - mollle lest Sex 0. 2 Date of Da Age If Veteran of V.S. Armetl Farces, - 18 - 20 n War orDat" bj O Place of Demb NogptA It matron or Ci TownorM a $peat Atltlregg W Manner of W,N®Natural Cause Accident QHanicitle Suidde Undetermmetl Palling �Clmuttumncis �Invm eEon 0 Metlical Carrier Name be Address Death CaNflcnte Filed Numlw Repufar Number Ci , Townor Vill a QOS3 ..D QDurial �N521 2D Gamete or Crematory ':; �Eemmbment . Cremation rev Q Removal Deb 4 It Place Rernmed and/or AIdiass —' Hold Dal® Paint of Q by Common S t by Certimon pagYrelion Carrier Q Disinterment Date Gemetay Addmss QReiMermart Data Cemetery Atltlrea Permit IssueE to Regutre4on Number Name of Fungal Homa Address 1p357 S Q4, M Ind In I Name of Fungal MaMte U Ao a ro WTom RemaNs ere Shipped, It OtherManan Abbove AtltlreasPern ///��� .. Data laden Is hereby to Gtrar 0 of tSt hunwynmtt by ebew ae Intllubd. De[e tssuetl 21 2O Ragigha of YQel $tapeGCg 41.i l/l�A riLOly+ 1 fw++eN D nnot Number 'aD 53 Plam W . Indiain C I cedify Nat Ne remains of Ne tlewdam idenEfed above ware deposed A of aocordace/will that Retain an: Dateof Dtapmbion 61u1m PNm of pslwsNon �� GlTarw� Pm®1 (+gel Mwlmwl c l�m.aal Name of Sexton or Pereourge NFe �law"iw ro Signature ��eg Te l /1�111VT (over) DOH-tsss (D2/200, 1 Rubliu HeulNf wSm. 4145(2b) - 013859 Receipt Humurremainsof deliveredou , 20.i.1 NneviiewNueview Ccmelery RcgrtantinB Nefunuvl M1ome nomad on Welal peemB (oEd,] Funeral Oiccom Rag,oe License Y—