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Surko, Jason Edward
NEWYORK STATE DEPARTMENT OF HEALTH 7t DU� Bureau MwMIrea ds Burial - Transit Permit Name Fnt Midi Lair As Jan,EMaN Burka Dined Demo AV A Venran of US Armed Forte,, 07A)SM030 QYmn waver LNe: narew Rnn Hour imiwo,car w Cily.iarmwVillave Grasso a Shm Aaaress 11Namwnny Annm,G Faka,Newyp l2Ml W Manne,d RaA ElNamral Caum E]4¢IAmI ❑Ibmkiae L:]Suiride ®Penelrp c MeeiralCemr r wins cNnmAame, mVem t dM rmWry MmpAv Cam" Aeeress sY HANuxo AVE.Gbu Fatls,Him Yoga 12NI Derm(e1T Filed DAMMumFer P�Aer Humkr C ,Tawld Vi Glxufwle Sfa1 p5 Ma an Dix Cemererv.CnmarcrymF:ilMR+ne FjEmmnammd Unnsei20 Hne N¢wGmrrebry Aaate:, ©CNnlmon a.s Uq Tm .NMYy ❑mumien ❑Ipmo"I Dree Plae rxmome ai andMi Hold Address a ❑TmnsyrNam Dole Paimd WCommon w msm came. Emission CID181i an min CemNery Addreaa ❑Reinwrmm Drug @IllelervAddress Pmmil x,nMm inn Number Name of Funegllxme MB Kim,Funeral i-mrs wN Wargi Address 136 against S B Gas,Far, New Yme 111333 Name d Furead Firm Mak,ra 01,4o,ilxnarm Wbm Wlnain,art Shimid,ROmr mnAbrc AMm, at M1 PermiaEion la liaiabYarantedrotliapow et tlla numen ramalna rlaeeribatl above ulntllealW. Dale Issued 07ga sh) Nagil Vdat Aninn, RdOSt Aup¢w Curtis(Eltttmnkaly SdndA /wdr ) unrest NumM mll Plxe Diamonds N,w Ym mNv m at+na remAn,d din maim mammas aem-a wain al:Pines d in atmlaa,a.:u mi,Pmm�an: Dart d Di,m,Bon PlamdDi:aa,aon s �i aw w N Q /+cam/ M1b% 1parenwMl gNameal5e,bnarMmn in CAelpd m 4, re M{W w verei Signature t f WHN5551Nha1 PIMx w Aic Heim Law sec. aiasfzd -. 0a3996 Receipt Haman remelns of � .4+n 0 delivered on , 20 Noe Yew Cemuery Nepresevtiog Ott funeral home named on boreal Mend FuN Directors Reg permit .or License#_.