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Dickson Sr., Donald K.
NEWYORK STATE DEPARTMENT OF HEALTH - - a BIRIaL- TrarWit Permit Bureau of Vi111 Become Name Her Mi&AP E�R� 2 Gttutl K IXhm Sr whdpalb Am NvdmranduSAmwdFewd. y mn5FAM POYmn wren Whf Place a Death NO Rijorrem,ull GrtaRii]Twm 9rtelMEl retie A YOM1I8m wMamerrof ® Nmullemv ❑Autlmt ❑Hmduh ❑suemmme o Mde aumbr Name rnl .nin Doper MI Address 211 GMrf S,Swlge Rome,,Nude YM liner. Death CenRfw Nktl qsW NumbnO .TmenolVifi GremNtl Gemw 451 LJBunal Oiz Femmy.EremadryarFailiry Name �EmmbmM glti/AM PMxav Cmrvby Auden; ©Crem e, (ammkirr Toed,.New Yak Duration F DDeNmat One place wDelel mmed Hold Address QTmamrtalim Dee wimd bymmnnn oeslna6m Under Drammen pate mmMymaau ❑ainemmn hale DenRmv Address Rrmn Nsuedm Patisr'+don Nu fumed Fumalfloma Gemnv.Fw.ia xome lw rwae Add,,, ]SM1wmen Aw.GNdr.NM York 128a Name of Funeral Firm Ma ma Dispfirion a m Whom Remains are Shippeet If uterMan Aline Addms 6 Permiasion is hereby granbl to iiapuas *Me human remains dsecxbeE abava ec inxir . Dead Issued e7Me¢020 Teglmofwalstei Loule Okmlewrkl iElemnlorly SlgllecD Duret Baader 4557 Nara Grearmajimu, NwxYM readily matte remunsdlhe Ja dent WariF r aMee were thaw"&in amended wMMis amem IN Dee of Diquiii 7 to Naed PSFomlon .+ IN u eei w fmax mmai facmmrwi g Name of Brand,or limn in Ouye W Premivs i Ild �r. rll rdPrwn `. w S,P.amm TWO DOH-1555(00 P a Ai NbHc H gffi Law sec. 4145(2H) U 126 23 Recupt Human ) ] . ? J PweY Ceme�ay /�-•� NePueotioB Ne fuwal fume nammwduial P��mit 09vW Movel Dirtnm11e8.ael.ireoee% � - '�