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Graves Jr., Gordon N.
NEWYORK STATE DEPARTMENT OF HEALTH L I Burial - Transit Pam Bureau of Vital Records Name Flrn MiMN Ian Sit Goman N.Gnw Jr. Dam,If mite Age ff aerand"Anneafortex 0710WM20 WYeas Waror Dnas + f vlxe of Dean IbWuaLinNMonor Z Cry.Tramormalage a Tom 51ren AMrtss +a&p nobx ROM,InXeGmpe Tmm.NexrwM +g8i5 I MannerdDeaW ®xanrnC.nx ElAromart ❑rmex Elsafair pumemix pm anig ndeg UJ annmamr..a ai0n Meaiw Grmxr name Tole 0 Axon Mavqukukyaiya M] Address M Murray Soren GMm Fear.Ness YmK lMl Dom fenAcae Ref DisMn Nummer Pe®mrHumhr Ctl .Town orNtlaw Uak,awq, 3W+ pBurial 0@ Gnomon,CrtmMry or Tammy Name p Enmmnmem 07AM2020 Pm Yewcommorry Address ©Cammmn G ,,,,d o Torn Nmrom ❑ Donaon pPemral Dearulna PemmM and/or merorxew Ndd Address tll pTransrynam WarPdmol o my Cnmmn sM moor Career Denmtllon p Disinterment Dap umwrm Add:ee, pPemhmenl Date Cemnery Addrt:s Permit in"dle hyinradm Numar Named funerallb:rc A%inner Bap+r Furrtl Nan 00W1 M09N Nwe or F, Wamneourp. DupYaM4Bffi Nemeolfur Shippem Making OiaFAlKorm rmWrom f NddressartSM1ippe4N WnmanAbce F Address W W u Permiavian le M1eraby granted rotllgaex of Kra human ramaina tlasplNad above ulMimlatl. Daminued 07mdrm20 ieglamr m vimi smi,Dp, n*r^"°2WKA1^'rerspRuaerpF4monvauysyna9 A�mpi Dndnxnmmer Bal Rare LakeGmm. Naw Yon i renrcv inn mp remdna o+d.aewem idpmared amm<ma ai,pmee d in amraan::rm mi,pprmn on: Damd nea rn _70lb maned mWaaion � nese..i W Q awwo /q'nwa bareeeJul gNanedSeawna Panama in Gaged Preg4s bueA / W Sgnaure iM• DOW15551ou"Pld2 Public HealN law Sec.6145(26) 013990 Receipt Human moraine of / XI I �� _. ddlvered oa r _ Rm Yew Cempary R[IIICtiDdrk die Pour or uicense don burial pi[ OlRtiil Fununl Dlttclors Pagor Llceoux 'J—