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Hall, Jeffrey W. 1 474 NEW VORH STATE DEPAgTMEIJT OF HEALTi�• ' ""� "°^m"° s«b°^ Burial - Transit Permit Nam P DOW of ell Vivanan of a. .Armaj Fwcas, ' � ZJ War or Dells Hospilel, IretlWfian oiSS"(" r. C ,Town Y Street Atldess Death swim Caap LiAbscanl ❑f Iune ❑Suisse ❑cirwne trena� ��ew�.�emo Medina) Certifier Nine Title +v MI AaMam Deem - sale Retl f �Cl YIIa8ber mbx Da O&uiel 170 A cremman ❑Removal Plea Remowtl enNor anc/or fleM HoW A�B88 IMh PaiMN - ❑Teansperaflan Shipment by Common DwYtofion Camer .% �Diinterment Rafe Cemetery AEtlrss -. QRerawmam Da8 Cememry AUEre°s . Pembl lssuetlro �.e9uVabon NumJrw Name of Funeral flame o YY' AOMess ` — Ae r ; a. rai Name of Fumnl Firm Maki OiepwNbn a YMtwn Remains are SM , NOMer Man Above Address Parmiueffli a ygmnb wdi p WMebuuu b abow f cass. Dare lase 1� Reaistrazof YfelsfeM1aecgnn (sip i— E Dist" Number Plana I wimty Mmme remekn of Me GeeeEem Wentlfietl above awo copose of bt rmrUenlee awn Mis pmmN am Date Noupwifion - Pow Piwaid Dopwibain 'R Je ✓:eu> In rs eo.Yof•l (aaarwl eae n rr77 1 (gore man ) Name of 5weon or Pen dRemises (Someone) s o ) 7. d4�MOIef�pI Cm�Jo.0 � fpleese p ' . SgneM Time (over) DOH f M6 (SM8) Pobhc Hcel law Sec. 4145(2b) , • 013868 Receipt i Humor mmvns of Je I delivered on Pine vew Cemetery R euiiny the Nnnal hone amea on bond pm¢ �� Poneeal Dirunrs Reg.or Lice u♦