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Heidrich, Emily J. NEWYORK STATE DEPARTMENT DP NEAETx _ Buflat - Transit Permit Bureau of Vital Records Name Frn unable fart de, mll J. Xegrk'M1 de,W Dmeot DwlM1 Ahe NVamanDaces:,AArmetlfomes. BRYurs Weror f M,,,of Dem, xorpli I'maution or 2 C'tlY.inxnorYl ONarmnl Vision Shme Address SKr C O.M tMNW,,WwYU iI W Manneruf Dean ® Nabi Cause E)Auident Momkes Suleitle E]Dnhnmrimd L JPendirg flrtumNrces Iand Was W Medlol CepB'¢r Name TW ZeMmy N,,d,,,C DO Addmr 211 DM1urQSl,SvuYga SpIngs.New York 12868 land,(mdiWeI Dinrit Number RgisnrMandor C iNs Townor Village AAwnM Nl Burial om Qmetery.Cremaforyor Fxili,=. � Enlombment 0&212020 Run Vkw Cremutary Address FA broodiness, pnanepury Tow,Now Yen Cenn 0 ❑ Removal Cam, Mae,Rumored and/or awmr Hula N How Address O 0 ❑iranspona4on OW Poipmem O heCommon Education,timer �Disinnrmen DW Gmeury Addren rjBeirnardi DW @nNery Mdms Ranch Issued to hymaum Number Name of funeral Nome % FunwMl9moM 01211 Address Yd Prus,Soml Po8ae5p;W uu ,xew YaM lit Ni Funeral firm Making DisposMon such Whom f Remai nsare Shiplowl.IIgMMmr Alge Address M w LL Idermis alon Is hereby granted to ElspoW of the human nmumads Eeswlbetl Wow as in2imteE. DMe issued DKutal Registrar of Vital Statiatin Pi BIdEkWWO(Elmfmirelly Slpi l+Mrsrwel District Number e6Aq flxe sainsIMMmuse. New YaM reniryleafds remains ofnw awarded idemiredaho.were d,,mwd W in accordance win Ads model on: mDan of Dispriten Wi 1p Pwreefoiapemwn BE i m+wu m r W..e.nerri Name of Xvmn m Perwn in Premises nL 1 &,facocm,, BE Signawre The DDx-I000lmnmwefa F �w Sm. mas(zn) 720 , ns of delivered on Repreemnng Ne funoid M1om¢named on bunal 'l Punerel Diwom Reg mLbenxp re^n