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Mosher, Norman K. NEW PORK STATE DEPARTMENT QF HEALTH I+ �/,7 vilest Racow se"°° '�` Burial - Transit pl r ilt LL NBnIB Rrst M. ( Ob test Sex �tl Date of DeaM ° ma Ages 1 INateren of LLS.Armetl Forces, Male Place of peaM O] Sfi 20 BO Warmpates _____ Ci , Torn or Vill Tovn of Corinth Hosmtel lnaplutmlq p Manner pi peeps 64em gddreas 3q puller Road ®Nemelcmme pgaBlaBm �Homicae psmaida puneemrmined EDRomeing W Medcel fgryryer Name cvmmaiacea Imes - Vincent Meyer Tiie tltlreu Mr) 101 Main St . , Corinth, MY 12022 Cealh Certificate FAetl Dietret Number Ci Toxn mMile Tovn o£ Corinth 4553 Resulted Number DBuriel pate Cemmmym rematory J' DEn(omgnen( Address 07/21/2020 Pineviev Crematory f{ ®Qema4pn QVeenebnr , NY ❑Removal Dew Fit Removed and/or Andrew anal Held Hold Date FOUR of by Common OBstinadon Shipment Carter Q Disinterment Date Cemetery Address Q Parliament Cate CemateryAtltlress Permit Issued to Name of Funeal Home Densmore Funeral Home, Inc. ymluW nNumber Address 00448 ] Sherman Ave , Corinth, NY 12822 Name of Funeral Firm MakIN Casism 4on on M Anc n F Remains we Sms If or Man We Address Pfficul 4on k hereby urmnfel W diapaes of the real xOM��eemyby w Charismata 07/17/20 thi im4arm Vitaltathem oP P n Indbeled. .� n T Drand Number 4553 FlecB Town of Corinth, NY I ceMN Mat Me remains of Me Leoream idanMietl above same deuoaca tar odd q new wph is Permit m: Dale of °aiM1 gsPon "!/ZI 11d Plero°I CiaPoairyon 4pjv (+wrcnl Pemba IM a�^anl (` (mewmmW/ Nemeof$salon or Parson In Pd, argBM Preml5e9 re ,c Signatu — (i/tlY// Tale De ) 01555 (Oy2004) Public HealUr Law Sec, 4145(26) ti x�ip 012635 Hinman remains of -L1 dehv on % , 20 d HMc Odicial eAHn uxfwaL Rmael U�aWspeq aLiceover �bm✓Feentit