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Montgomery, Kenneth Paul
NEWYORK STATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name Ford Middle Last Se. senator Poll Me MeY pealM1 Dar me Op ff and NSArVmf ds. ovnnozo Rveo W,rwoales f Par"(halh mars it nu m "or Z CIry,T,,,, it Gre PoY Aestr ad [s Os :a FebxupNal oMenermoeath © Via Fauae ❑Accident ❑wnddde ❑Striae Du:delnmi::ee �PandinN w Cirtumste:rtm InvenigN11 W Medialurti Name TMe O some Member Park Address 1Ntr0.M1h tlwn FVW, Nm YM tt101 Dean Onifl,"Flka oi[oiat Number rLLgiarer Number City.TowncrWiRtar Game Falk H01 4 ❑Bona oM Cemmi Cemetery or Facility Mane ❑Enmmbment mrzdrmzo :.m.mry Address QCremun Gueeastury Team,Nmn YUM l] Session z: nNea l Dge %re lknmeef F rAkr anch Nele Head Address 0 w QbyCa aratimr Dad e Po'm1W S Under sni Omer LkNru4'm �gaimemenl Nh Ce:rakrYAdd resr riReimeemld Data R::etery Address Permbls'u= Il�ar on Numbee Norm Funeeal Nome Nayrum GBWVFumnlXwrm 01199 an ade" 11 L1foi St 0uee aamy Na York 13tW Name Funeralhem Max:q CiyuNunorm WM1om ♦• Nemams,re ST Pled.FDNennan Abm s dress W n Paymfaalan le M1a=dl�� e Manor remain tleealead abeYe ee IMlaalad. O,leI..bed D704mis ARK 51"t, V Vim 14541tl^'�/Dialect Numer Nm YOM I[mily1M1a11M1e remain[d Nedacek:NNemiRedaWewertdie{onAolin uuNameMMlM1ii PermRon: W Dale of Diapoaitan 7.24L)y0 Plaedwsposibon �,hey�L. Lrdsrva fps a w rd /wb:l J lle 1 ry,rtevMl Name of Seamn or Permni n rD• :ads 4` �e p.r =1 w Sgnaure Trader L�smai /Je.•„/o/ DDx-tsss lmdelpld¢ public Healtb law Sec. 4145(2b) 012670 ( Receipt 1 Htunon rernvua of I-n T n I� l delivered on 20— Py Yew Cemeury .. � RepnundnB Ne funnel home onmM on bunalpemm mew Mo nO piney Reg. or License M Y