Fish,Gloria Annette n �s5
NAY YORKSTAIE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of VOL Remands
Name Flm aJ4 UB k'
GI,,,Mnetlu Frca Femeb
Oabd NaF Me If Vttnm d US.lmea Fwrtx
p53y2J20 warty Mm
Paced Omar IbaPULln9im!ram
Gly.luwnor Vil Mnu�iorm SUMMareas IY]Prynoks Pe, Moreau lr w ,None YO* 1210
p Maonerd Rath ®Noural c,,w acaeem pH,,I Lisurtle �Uneme^ninee �PeMlm
ly GrtumSbnas Ime9i
Meebl Cmater Nam rnk
cM ri Mum NP
Address
9 CareyP .WxnNury Tom,NMYM 12DA
NaM1@aRem Fled 4D:0Nurt#r 27 Numhr
Ci .TownuVnl 5w
❑raved Fee 4maRrY.6un4W w FaiN name
❑Emumem:m 16]rea Yw CiuWMom
mmyr Duwwdiry Twm.Nyvm
❑Domaron
BAR face 11,710,041
Nanew
Brief Aeaw:.
g ❑mmapoaemn DIM! Burka
em
evmmna^
Came, Deamaon
F1Diammrmem Dale remebry Aeare::
El Far Ow Qnxmr/MaRu
Rra115mM W Re®Neuman number
Named funeral Wme Cdeb^FunaN l4relnc
88 W,a
Be Mad Fumed Ar eo.dT,HNewo Fa lb,whom lms
nme%F.retiTim Maaeolan slbnnrmwmm
F Immm^a are sniPrca.namrm.nAme
� weaaa
a
pIFmlNI is MrWr gmnW b alePwa of Ind Numm meNrue tlMe WeheVa m Indicated.
Dab issued mmY Warrao(YUSalines Gmmdmu&I�^'mmwdY Sy^aI
mMwm
oinm Nnmuer uax vlare Mores" NehYm
Iandvmmlle remain:dine::meaemmemniaaenbhereeiawraaimawobanaealnmi,me^^nnn:
W cmeNRspuuFan le7 Paedds(atitian .G f
2
NO
Q merry/ M cf b wlMM
g Hanred Ynonw0.+mnin(fi dPemi N� m
Nreh
IN s¢nmre ( ram
DDH 1555(WM)v Iav
Public Health Lew Sec.4145(2b)
Receipt
Haman remains of deliveredon_ _—; 20_
i
nor view cemuery Representing the ruuttvl home named on burial permit
(Afficial Funeral Direct... Reg. or License b