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Tubbs, Michael D.
NEWYORK STATE DEPARTMENT OF HEALTH - Banal - TraeSlt Permit Bureau M Vital Returns ` Name FM Miaak bat Sn MbM oTum; AWo cneolum Pge IT VmI11 W UA Armed Fortes i M Yemeni Warorlham Vestment Nenm Death City.Tram ,Year, Cknti'm m ro=Fang Hasum 01 Manmrol Dram ®xnmalbn,e ❑amment ❑Nmieme ❑SUt& LjunmMmined �Parrame nmomnm.a, Invest' Memeal(OMmer Name T& wanes, Mn Address 100 Peru EL Glenn Fee.Nw VM 12901 That Dunham Tied omit Number Ryrtr Number [i .Towne Vill Duane Fam Z1 Budm wan [emmnoreemmnr meter Name ❑Emmnmem � P'm Vmwemmmon mdmm ©(remmmn puknffian Tcxrt Newym Don �Remwal offi Flex hmmee anator "dF ,Nele Heiu mere„ ❑Tran,pon.Yon Data Po1mW by ComesM mean Came, Neither, _ Dan Cemxmymemss ElAnnhmrent om femmnatltlrt,a Forma Issued to Reparal Numtr, Namew Fmmml Home em.n FumralH"`m wall Adam„ 24 Can Name PG Em 5D) lone w:erne.Ner,Ym laden Name of Funeral Finn Mean O smiitiono,t,Wbe a. Pem ,,are Sh d.It Other than Above AEares w ganniWon Is M1enby gnntatlroaluminum eb ma human mmeine Eeewibed abew as indiubE. Date Issued 081 Regiunrof Vdal Stnise, 6gvmrel Deri N,nm, 58'J1 Nam china Fn& xaw York I ,rdy men the remains Wth,medem mernmd aborcwem digmad of in uom mwun Nla AZ n: WCare a ni,Pnemn 8h Ib Pbmdniegoaidon m 'lam w aunts;a `ruwMlf mri e wan mxmnmamnnin[narsmr , en i IN Signnure Title ooN-1SSS INM1BI r eta panne HeMdh Law see. atas(zn) U 12 691 Receipt Human remains of Relive d on RmY�we,y Repms ooe Nef Mha oamN aoL _pv t O&wl Ponenl Dirtnas ReSmLiareeN