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Mazurek, Kimberly
NEWYORK STATE DEPARTMENT OF HEALTH ` Burial - Transit Permit bureau of ital Reeords Dame HILL Mleale List xa mmoen wv«ak « w Date of W Ap aVenran of wes twos, mwzox urwa waroromea P. Hr nWnbnor Cry, Lvl taXe T Emhart Adrt 107 6ub ccun M.& hmuTmm.New vakr III] Rnelq O or ane Lot @am © INamoGnu �Amidrm � bmuae snit& � 11RH'[ at cwmMnae Im wMedleal C! i Name Tale O Wr9imarna:pf cmwr mere: PO. Bab,rnnBr%Y6 New YOM NPFP Dears C<nifnM Fded District NumEer Peginer Numhr CM.Twn mVilla nn make 2059 Burial Dare LIm N,Lrtmnory or Is Lily Name � Entombment mAmdreite Plm Yrev Cmrtubry OCremAion drmnWury To+m,NewYM Darrearn ORe.Dat Ome mn rHeW pions d ana/or Full Aeereaa a �I .oynnauon Dan Pol mem L mmnn Ship D lti w Greer �mammlmemm Dan Gmmen Aearee. e rme Dale um Address Ri Perms lasuNb Inralun Humhr Ham,at Funeul Nome Milwr F ,I Hama mares a3s]Nn Rn r 0D IIOW Wu.Nen yO I'AiR Name N royal Hrm Makirg Dlapenan orb Whom f Remama are snlPRd,If Other than Abu Aar all 4 Peembaion is hereby 9nndW to tliepwR of Me M1umua ne lexribetl above as intllubtl. Dare Iasi DTmermeo BeNinrarmviml Sradabi dlleA Oavvr(OefrviOly9gIZA yynuie/ Dlnnn Worry pMt ' Pla[e III We, New YM irry PM the rtmana Wtb de nt needed III seem dispud of In armandanamile6i5lermalCar: w Dare If DaPaaidal llla 70 Plana Dishol r ] s w mrarmm�r ]rpw^*++ Ee nemwa] m z /i/ Name eL xmn or Pelnn in Carrier or 225 In ap �a w Eagnabre TRW DOH e555(WM P 10s L Nblic HealN Lew Sec. 4145(2b) 012601 Ptm6pt Humao mveios of delivered on . 20__ %roYaw Ce Ren,menling the funeral home named on burin) p 4 Official Funual DhwanrsReg orIkea,R