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LaGoy, Scott Edward r L NEW YOFR STAR DEPARTMENT of HEALTH Burial - Transit Permit Bure uofVital Records Name Fire Mleme Lan S. smaHwme loan Dmemann Age nvererenmus Althmwlrem, DvuaexD sdvmm wmmmrea t _ E. Place of Dradd HoenornnMNbnor Z [ila Team or VAIRMI, m ran Sren dodner careFen: odal MI W Manz'olarsl ®xrbraC,w � tlR< enl Hnmiiw Same, LjVnwnmime � Paneinr Llrtumnsei anigarbn y Meekal QnMn Hems TRIP MYa ead:M/ae GO Neerem IM Pan St.Adding Nea Year 12MI Omm,aNnrm Feeexl,• wnmxumxr Parse ,meaw LIry.Tvmn or WHUNIN Gle:m Fab `Meet DIN Bono Dare c,,m ALremdory or None Name ❑Enmmnmem owlaaozD w.er.n.lo-r Aadrtn Oc,suma Gme:lwoury Tat xvv YN ❑onn m Dorm vibe Remmen 2 ❑ mm.l Fmamr mepr xne y HoIE MAu E ❑Transportation °ra M S Career o amneder, �Dleimermmr LAW 4n.ery Aeeress �Selmermem Data 4rmtery Mareaa lseuM to Rginr nn Humber No,,W Iowa[Home Swromm,SWrren Food Forms Wore damn 407 Bar An Commodore xmw Yorkw Izs Nam.At moment End Making DiePnstlun or an worm f Pamaim are Shipped, fMe'AS,not rl aereo Pam IPalen Is neroby granfW to dLwow of Me humwt r alns sea bW .Mew«mdim4d. D111 lama w1wrM Import one SUIMr PN/.V�✓LiTUIMFn,ms^nS Mom✓/ kbmuel Dislnn Number At Made Olys Feb. Hew rem F randy AM the repairs Wne esswm lwnure Momewre dMyma N In auorNx,end this Mmh an IS Date It Dopecribn 4 n W Plw.ol DePoaNnn NO dmaW w rwnMM I rm.an SName of Swkn AT Seat M Lh7IM, Lr '�'wl•— SrOnrY w Signnure IRS, t a DOH 15551mM PINT = )13941 Pubc Health Law Sec. 4145(2b) Receipt Human mmaim of delivered on—, 20 nw Vim Cemetery RepreveMog ow mmen)Mme named on burial pnmit Mcial Panual Dimmms Peg. or Ui mse#