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Nolan, Mark Gavin
NEWYORK STATE DEPARTMENT OF HEALTH BUffaL ' Tr211$It PermitBureau ad Vital ReroNx Name Fm MiEE@ LAN XM Mak Ge+n Ndan I nose DNdIXaN Ar Il Veteran OF US Armed Free; cemnmm mYeam Waor Dies H PIaW aMA Hospital.Invaders or �Zy C" ToremorVilluip Gkim Fab AIttIAEdre¢s Gbrs Falk FIONOW1 p Manrerd Deans ® Nawre unre ❑Aaritlan ❑wmiride ❑snitix �Undebrmired �Rodl!s . W ureumaaax Rod Medics Ce— sure Nx IYrvii mmNnlM1 No Address loo Pam sn Good Fans New Yak 12WI OanceuaAale Hmd DimN.txumXr xyimarwmber Cn .iswnuVil Gbm Falls 50n1 Pm ❑Sam Base CameNry.<remamryotFwliry Neme ❑Emwndmn nLtIROM Hm Vwcrwrrelay AWrtu ©Crtmaion GrmnYury Tqm,New Yens Domain O Hamaaal more Place RerzalM f and/or anarxew y Hdd Address V) Transgressors [Farm Fima a bvmmnnn sni men C.rbr Demnman ❑Di¢imemum NM Cemelea Address �Reintannem IkN umeMWAeemss Rand Issued in ReynBon Maker NamedfunNa Homa MBwMaFuremlF -n man Address 123 Pan s1."Fla.Now YOUR lPaos Remains meShi Fnm mOtherDixmxmmamvenom r Aemamr aasniv .n0lAerlAm Max E Adders 6 u ParmiWm to Aereby gmnW dg dlepoee of the human remains de be above as lndkoo M. Core Linea oerlloau R,giamrdvmlNawts Wvumzwaa cawde fE�amNlmrtys /NM") oisdo Named Deal Nxe Germ Ftlq NmY" I CMav team rcrums dde deadenidemnied uMe weds dispmNd in aaoNaNe vi adsFori ,�77 Daedpismsbian (01 1C) Maedxbpsomm �l s rasau W N Q pMbtl lMmmr%q pore merg HamedXmrahmnln CAargdP/°/^�//!� A OFFDigaure ( / s Tme ss WH'1555 RoVAPldP rnnno Healt Law sec 4145<4t7 013916 Receipt Human remains of delivered on - . 90 (t_ Pve YerCwetery Repmlmnng the Mme mmN on bminl pemtit mcial FLneml D'venors Keg, or uce eM "'- r1