Loading...
Shepler Sr., Robert James NEWYORK STATE DEPARTMENT OF HEALTH — Banal - Transit Pejit Bureau of Wul Records Nano Brn Middle Lee Xa NaEeR Arms Hw "r. AWe OMeaIDadh A/ If Veteran of NS Aimed forces, learnconcemvon. WaorOms F. Plan of Month IbepilaLlnsliwionor Z C'ny,TownmVil human Town Areal Alpress 4sB Bowen Had Fred,nodded Tom, New rote 12M o Manner of seam ® xawat Cause ❑AMWm ❑rands x ❑Smide LjUnMermimi LiRndi did an w Medka Cenmer New Tire 0 Need:Dow xv 47 aee Mean share We'd,farm.Nam Yale raise ceAn omr Filed Dlnm number COM Number C' Burial rVil 5s59 CW4 �Budal Offi Cemmrv.Cremalwyor Fail'MName ❑barmbmenl AG�A PIneV Cremelwy Address FX cremmion Domesday Mae,Am Yet Orriewn o ❑Re....l Om a aMM a nd/or old Address y ndl O //61 QTranspNl4n Om �mm O byfommm Oesdretim Carrier �Di:mumam ses KemmrvAdeaee ❑Peinrermml Did, [enelery AdNea Perms lssueaw ReiarNm Number Name"fureral Nome Ale✓ander Beer Fr,ws Hwm WNT Atltlasi Name f� d St,Wannerad,% Nee,YOM1 M5 Name of FreMFare"in Disposition Onto Whom Remains ere Si ,If(metM1an Alose Address w n Permission Is herWy granted to depow*MN,homes manalna deawlbxt Above as indicted. Too Issued 0.8,07NIM) hgiNaro(VilalSWnW Suwr Mplu lrEKettmvuPy lrMa�+l Dlnnal Number Ime) Plare Arm, Nµ YaM .mfy mm me am.ne a me er<exm ixmaiee am..ere ai>pwee a in erwmeae wim mi.wm,u nn: WDale ol oiswaMnn .R.SOln PIa[eJ oiaPnsitioF R./e : .deco Croen me ad s w a x'�g/ ✓� lae.a NameolXmmaRrmn'm CM1ary<ot Fn fp 00 2 w Si6'adowe Tdla 5511-1555 ImM1N p 103 i � Public Hcnith Lnw Sec. 416$2b) 012694 � 1 i Receipt i Hono, remains of _ ddivcrc on—. . 20 i i Pine Yer Cemetery nam Rcpres of the thmmi lwme ed on m,d permit Mend Fmcmi v,eaor. Ras. or Lianm x_