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Kussius, Bruce M.
4to NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records ' N... Not Middle last Se. Bruin M. Reuse MMe Data W@aM Age NVereran al Afffed Fortes. wa,uroakr ONNORI Remain, _ F. Rare orM losple. 1151 all", Z Ciru lowmor Village Chi Tom B]3CMIy FRAM 10.Oue Town New Ydk 120M Manner of hNM1 © Hnmal Ouse El modest �Xomkide �SuiNe Undetermined �peneing W G¢umaam¢s Inmligatkn W MMIT"Acmarer Name Tdb e MkhamI MR Address Pram Romd.wemawry Tn.n. Nine YOR 12801 aam CMificareI RIDin Number BeearlimMr C, .Tu.nur Val and Burial bete cemerery.CremeloryorFaitily Xame �Emomhment mMrzom k.Cremewry Amen ©CIMMion seueenqury Tmry We VON ❑mni z Dee vha.Wmwed Fnk�w al aneror xele m Hold Address nTransponamn MM. vamof hYCommon Shipment Omer Oessnnwn Disinterment NM Cemetery Address 6l@imemem bew Omekry Mdress rtrmu Issued to Remain Number Name of Funeral Nome X rrerMRomelm W211 Addres 2a Chord StMMEmS Okelessxna. nbxeoMunue Name W Fumal Frm Making oispsmonorlo wwm f Remalnsm9u pee.NOAerthm Ahm g Address 6 W LL Pormiwlan lsM1xWygranted to Efapaw of the woman .ins describedeEm.e don indicated. Dee Issued 01M/N20 Ikmassaw of V nistks raal Al8d Yallaal P&admlly9glo hryVmT) OisVin Number 4RI4 Wee FMlbe Newyork F only the the remains of the dee Rind d aCrm MR dispasee of in amNarce Bah this peral enr Wom of 0ispsidon Phu of Baseness � leaerr anMi Mwrv4er/ /Prcm ld Name of kMm an Perms in Ragas prtmit IW�wn,N W Signeuk TA, o0N-a5551NMI p1Wa I Nblfc Health lsw sec. 4145(2b) - 012656 Receipt Human remvne of 'i delivemdoti . 202 Nnevimcn Ramseoft tM1ef rai M1ome ovmetl w wriY*ernh mcilit FuoQel Oirtc�m.+Re6.mlxmse tl., :-