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Archambeau, Howard E.
gig NEW VBNM STATE OERARTMENTOF HEALTH BEEfIaL — Transit Permit Bureau Df Vital Heswds Name foss Middle Us Yv Hmwd EANemtws Meb Dateal RatM1 Og IfVxran a LLSAmed Wrta, onxarzom ssve.w wm«Date: face of Death Hound.I natuma CITY.Town or Vj lage Wams wrifTown AM1eIAWnss 5]BWBbbatenMe.waivYa ryTmn, XaxrW 12895 Mannerm Dean ©Natural cure ❑Acidem ❑Hwname ❑Suaide 0umaelemn�r �penmmg eNumumea imem t mm'xtl tenirwr Masse May s Address He DGm)Xwf.WeeneWryTwm, tM.v VaF I]9M Cmslo mo,Vfsee Dinrin Fwmcer FsysrerxumEet C' awmat Vlll Wamre seem IL ❑BUNI Dme Ca^elery,Cremscryor Failiry Name �Fmomnment dAdress Rne Vlvv Cremnory ©Cremates tymnyvyiwm,Ww YaM1 Assume" O ❑Rams oh pluhmM andlow anAw His y Had Addms Q.0 VI QTramponnbn Desk Palma brmmmo, sni mess Cater Densities Q Disintem.m Dare Cemecery Aurexi �setnxnnenl Dar CemNery Address permit Issleam separations mker Nameotfuners Home Alm en,i mFuremlHmm O Address I809 Mass St.Wamnaeurq.New vnM1 Imes NameolFureralflrm MaBng Dlspsirionorm WM1wn f seneineam%i IIOfl,e, nAWee s Address a w � PemtbYon Is Nxaby gren[etl [o miepou of 111e Women ramalna daumbetl above uintliudm. Dnelssnea mmaox Rest Vnat Aadwlas sumnN ety Sct,m,JJFysgn.Q Mgneme DiAnm Number see) Mas wmmmnma. M.wvwr. I amity"He mains Wne cement HeMtliN abrt veve dirpnsi W in ams me wM this insist man, Dm of DispDnfian 727 zrnoMaama:pmitan �,h ev rG G IM w ar w in emnr 1 am..wi m..rreren SName ASemor, Remains I' 1 eL� R w Sienalure iNe lB vrtF / DO&g551D1491 p1 v I Jic He ffi 6Rw Sec. 4145(2b) ' �12661 Receipt Hunan rcm m of iL 1^,j ac, (W�lj debve on 7 2 ) . 20s2 euer�ceoumy x�weKoims �mo,m9quma 'i �� Muiml Ui tma lteB.wLiceoxR �Z�