Washburn, Clarenda E. NEWYORK STATE DEPARTMENT Of HEALTH a Banal ' Transit Permit
Bureau M Vital Records
Name FlM Middle Lan See
E Woodburn EB14M`
Dow a owth Agr If Veteran W .l Aimed Fori
coorlowo ftyw WvwDab
door,Deals IbfpileLln9Yubntt
W CM.iorvnor Vi Lab Town SOMMdrtsf Yti2GYAseI.LMe Li¢eme Tvm.Hex Ywk tR610
p Minimal owed O Rnmal femme ❑haNem ❑IurkiY []sired UndenrmineuProrate
W urtm meA e
w MedkaefeNfer Name TMe
G Wan"era MED
Andorra
order Rotl,fywWxy Town,Nary Vax tlHM
Deanfen?eaM EJN OimitxumM RepurxnmM
G ,T n'mi Lelul,mw '"mA' 0
❑Banal One femMry,CremaoryafatillryNme
d to boom Address
rwdPYMemrLmWry
maun pueaWey Tcyw Ne,YM
ElDuration
2F1 W@ Plxe RmmE
or andMNeW
m HOW Mdml
7Tremponnon DaN WMtl
by Comm" So `
nd
Ortcem @Anson
Flo...numem I fenierery AAdrtu
[0]Reiordinary one QmeRmYAedrem,
h"d H:wd1, Fey'nnlun Numntt
xamem Pmmmlldrme maAN
Adder
T sn.mnan Any.Comm.Ni York 1281
Ready.... Firm Mauna LNsposnun"n whom
f Ramaln... impow,00therAwAi
Add,,,
2
d Parmleelan la naMYBremed 0^alapaae of Nelwm.n meMa tlaWlMd abnw ee 1nOlwM.
ole lamed omymm Pealarmoe Vidal 9ninb Cyrom4vwM 11-w4nninity5gedl
nro�a.W
Diann Number sea main NwYWk
11 enip maybe remaimsMNeenetleitidmaled almeown,imposed of No irradiate wA Air palms on:
Wown"oim"an" 6h m maam DBpmnun .N /
S
m
a ra.xM ..axe
gName M Seelan or at man in 0 aipN /f
w GN
Summit, Tine
DOW155 rwABlplall
Public Health Law Sec. 4145(2b) 013872
Receipt
Human remains of delive
red
on , 1A (�u
One Yew Cemetery I(eprevenHo6 Me Nnmil homeoemetl^u banal�enwl
Ofiinnl Fuoeml Dvecwe Reg.mlic p� /J -I � .