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Surprenant, Elwood D. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Tra11'S"d P mit Bureau dViml Xttmds Name Am wdie Izs Ye EM DSury:areii MaY Rmd Ram Og XVereran U,l Armed Wl¢; wmxreoeo mrmm warorom: F Pma d oeam HllpmAlnaaubntt w ".lurmnrVH pYrm EW 54eerAeareu PLeFeMNWeI ww M ,nerd Rem ®Namleluum ❑Acikm QNmYide �smajmm pundmmimd �rtnai% Ortumamm MoWmim OMediol Cenifrtr Xaee i N /uenputlry NO Aeart,: 1W PVM1St%m:il FaM,rM YM lfbl ttM[mn i ne Filed Xuntrr iorVl CFM Ml 2 47 Bun [ Humkr Doe F.mHerv(remamrvorfadih Name DIMM020 � Enmmxmenl Address ®Lrtmnon peagpuryian,NV YUR Rn Mn o �Ikmnml Dame Ham Xemme anaar .IM/w WN bld Aaam �irenfynwon Deep Pdnrol dymmmoo Slliemem Carrier Mmnam� E]Ddrmrmem DAN Rmery AMreu ElFeinmrmmd um, Camenry Address RrmA lmmdm X o Rumba,N,wdFurenl Xome FMmLNW FuwNX[nx wG18 Address Sw.SJvmr We,Nw YM nVM Named Funmlpr Mmkdhapfiow WMm 2 Femansare SM II%kr111an More $ Address Q W d Psrmleslnn lw NW WYOmbtlbtllNpP�Pf gmlrumn mnYm tluwlGM Wwsee lnwnbtl. Dam Issued Q'1QRDM Rgabard Viral9iiYn $VSmAn6ty CbNl�la'M1aimtl)SVem!/ DNmn.d MA,d Numter 5m1 Place CAymiW. Hw YaF anih and rm mnaioe d ma demaem meMrrta.Nme mre aLXmm+d in a®dmm.m mh Pemx an: wmredoiaPmmae yla3L Pled w>m:We ,., Prlti f wam w Q m.ra.1 .mmAW xamemsmeorrtaenincn dvremime// Ilnl smawre �=�.F TXm CdN-15550VAMP102 .. . f) 2 Nbllc Health Law Sec. 4145(2b) 1 � Raeipl Haman remaos of _ delivered on . 20— i RtPreventinf the funeral mmne vned on bunal WMt Plne Yea Cemetery Funeral Ulreum O il rs Reg-mGwaseA — I