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Shelly 111, Thomas E.
NEWYORK STATE DEPARTMENT OF H EALTH ~ �� Bureau of VINTRee«es Burial - Transit Permit Name First Middle faS Sae T1wmmE Shol III Mrs Ned Beam AV I/Vekrm of OSAmiea Forte, 052 = 51 Year, Warmpuei 1. PIaa A Cram Houses,InsmmNnw oZ CTv Tawnn Vi auawMu ram vrtelMereee mWlTwelbmmin Prow,gNOWaworeI N VM 1]BY Mammmoeam ®Nalmal ❑Assann LjH mk& LjSuIche LjImeemlmlme �Remim U C'Irtumnarees Inverse Medical CereHp me e Na Pak Camaa yeo Adareu 1WB51 Pcup9.laFOGevpa Ton,Nwi Yat 12015 Cram Grtlese Filed OuTrc Numha Ruyuke Number Ciry.TownmVT 5,,1 112 Buaal as @mekry,Cmnauvy or Fxiliry Name � p m Enmbme PbAew Cimrc'blm" Address ©(femme" mum"Town,New York ❑IXnaton O ❑Rearrest Owes Flatthmmed and/a an4w&le Iola Address O w FlTranspurtson Oap wimw Wmmmrn dM,,Xm Exm 4ninaum ❑Beimemwm Bap �mNery AHareea LJRe.mnararnl Bak CenleMyAeeress m meluuAm &giI Number Nameorbureallome RerMiuneYNuramo oIQ6 136 Aaareu Warren At,flmm FaN,NOW VaIX 13801 Names areShI Rsln Matlrg BispuNonosb WM1om t Pemains are SM1i H Diver than Ahm $ AEartss 6 W n Parmission is hereby yeenmJ to EiarposeWBear human resmains FleaeribeFl abusers are lnlleabM. Wm Issued BSI22f2m WwbnarodV1,I5m11sks Camllne 1-11"I BaNer(El¢hml[ally SlglNi) 114" / Binri[1 Numb,, SOFT Plme pameWry, NI emry marl m«amain.a me emexm ieemRee,brye ware aNN,em a m aawra.rp wMl wr Prone m: r r W B Ce,,,W, Li Of m ¢ pneW m..ffi.n Now gNameW 4rmnrrhrwnin agWR rSO, aA W SKPawa �. f TA l aP'btl WH-15551a1MIssIX2 Pub"c He ffi Lew Sec. 4145(2b) --� 013866 Receipt Human remains of e� 2(/! delivered on 20 - NueNae Yw J �. Official ReNw pnB the(uoeM yy PooeN Diaebn ReB. m wouk Y� .l