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Caldwell, Glen A.
g0° NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau M Vital Records mass Name fim Muse NA Box Glen A Nuam Male Dee ol0.aM1 AQ If Warren W V&AmN fartex OM!W20E0 UYN WazarDNs F None of C¢M IbspilaUnselWun or 2 my ToonnorVill$ $ jsdjar s 13AeeMB San SglMl N"Yp 12M Mannerdoeam ® wMra rms ❑Nou ❑1lmdrda ❑Bumde �undearmme; �readrM a� GK mnames m.sigawa IY Meeed@mfer Nam!, Tnle O 5wm llgsymu Caere, AMma 40 M W tlr SRam.PYwm SFai Neu Yuk I= Desh confess Fled Mmot Number Romer Number ca .TnwnurvJ sae em1 We ❑Donal Das fenNWry.morommo-F&JUNNme ❑Emonshoem NoDooWN) =Oenaery Address ©( Iam Mummery Two.Nw YM Donation ❑mom Done %YOV oeE andror '"d°rMtle a Hold Aaeress nTromporo n Du $Aimircm bemmrmn Omar ❑Disimemem Dare rmereW AeereM �Reimemem On` reAAtlress Rermil Nfueb Rommmamber Named Furerallbna N, ^mm Funeral Fomm Address Snmmen Ave.Ur o n.New York 12022 Name of Funeral Fi rm Mating Dail or to Whom Bemains are ShimoE If Career Ban,Ab.e rodeo, R PermiaMon Is hemby gmnba as EiapoaM of kM human hamainadenallbarl above as inEiulM. reformed WOMEN20 Ne®mard Viva SlaiNa Jon Pad FRMk(EICV001GIIy S19Wf mm"Ro, Dann Number 4601 Plae Barroom Spdrg None York I arliryMa the mean raft means i named 11m,oareal:ryree don acommm wMNU Remdae DaMd oismsiwn '}3e-zew PI«dbispo.man /`� — C Deer 1 f.Mm.Nn rn.amlw.y NamedSeMrwhmnin dPmnisss vN oor G (YmepWl gumure TMe DDH•assslmnn P,ma Po IicHeAl Law See. 4145(zb) 012673 Receipt Human remains of 1 YexYea,CMrteallW e t Mmsl Di ias 8eg.w