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Braynack, Nancy E. #%36 NEW STATE DEPARTMENT OF HEALTH Bureav of ar AviMlNewrda Burial - Transit Pernik Name FM Middle Inl Se, rc EBI Dnem Dean fmmk OT/IaROM Y IIWe... odes forte; n vmm war,arc, Wf CH Tm K Mearilal baliMbnor Ci1 .Tm 1 warren.hu Tovm Yrtelnddrta, GBS]sleb Rook s.WermnaurN Twm. Nem roK lzB&S w Manne,m BeaM1 ®Nmralfaua ❑Aumem L_jNorl ❑s,tida o �Clo am wni b eW ma MMkale er are m ai i kbus sem A Dp AM. BCamTFm].e Far! yTvim.Ncw York I360a Dean femorVl fi@tl DiapMNumMr pegyykr Numner Ctl .ToxnarYJ 50 1i ❑ Banal Daa Rnekry,Rnorym I'mfxil'M Nam �Enbmhmem 0]IITTNA P'mg Ylax Gamabry Address Fx1Cbm00n pgenp,ry Teaan,Neer York Elnewadion Bab 0 ❑Pemral flxa Pmwved F ardor wxVw Held m Hold Adtlrtss O nTranspHatim Dem PoWIm Carrier DeAr"a, ❑ maim.mem °a` umeMrvAden,a ❑Kenmore Dan feimlervMtlress PermnlaaWro HepjAetion NumberNwemfurerAHow n.®nexmwPumrl wi. saw] Al 3MB IMIn$Wartmuhrq, New YOM113BB5 Nameof Fwaral Nrm Mdug Oiefo,ilbnorw WMm Pemainaare$ni md.Ifom wum A6M j Address 6 ad 4 FM lI Is h« Y elembed an alapose wEMe human a.malne dawrlUml abwri me Inmula2. face Issued 0711T1OA ggiprarolvi1al5k(sns 94^e65N CG_M(24cr mnvaQY signr!/ sww Dmnn nummr saeo vlxa wm..mra, Nmrrm i amrvmmbe rememalredamemieem�rmart..wene�p,edmkarmmara.mmbi,prmn�coIn: r/e/` One of Diryastlion jo jd Flaeolmncerhm r UN. ✓14ry� amw 1mn«1 wr T p.. = Nam MxmoarRrsonlrcM1ame N�mire: � I1r/ � SNAI{ R{ Lgnmre � � iyp WdK DON.ISSS IaI/181 y,ofv hblic HealW Law gec. 4I41(] ) r Receipt 012629 Human remains of ��--5 — delivered OR4W Repre,,nrag iecfiiwe lLumcnamnJ onp WF f 1'ooeml r ieeclors Reg or License Y _