Lombardo, Baby Nevaeh NEW YORK STATE DEPARTMENT OF HEALTH n 9oy
Vital Records sepwn Burial - Transit Permit
Name First Mill LY 8mi
Bof Neveeh_Inmbudo FewM
Deb of Oea1M1 Pp If eMron M US. NrreC Forces.
8/412030 0 Wean Dab NA
Place OfHOpWI, cons umer, or
S Ctl . Tor wen or Vllbe Gkve Eel NY SbMAEbw Glma ' GImeF NY
Manner of Death [K Natural Cause []Accident pCircunwwrerehorsewomanpe horsewoman
IUmbelermNa LFo"°p
W Medical Cerlifwr Name TIIb
O Ot BeilmlMD
Addrw
100 Pmt Svm,Glms Fe Di NY
Death Certificateor¢b Filed OIeWCI Number py,�l Rpbbr Number / I
City,su Torn or VYlepe GlmeP NY �+sPP++ �I
❑Suriel Over
CemelerYm cremelP
August 10,3030 View Crmebrium
�FrorOniew Mdros
®Cbme4an SI QuFluomtl,Dusenberry,NY 12801
pglg Pbcc total
❑eemovN anNor HNd
Hold er Atldreee
Data Palam
�TAnagdallon Sblgmnl
p bT Common Desumb
Carver
�OMlnrermaM Dow CemebrY Address
❑Relnlemwm Dale LenmMry Address
Parmil lMued b RegistaWn Number
Name M Funeral Home Reeo Drury SWi Present H®e DIN3
Address NY 136W
53 Qm6a Road,f2mmeEmy,
Name al FurerN Firm M DiDiWm on or 0 Wbmn
t Remains are SMppe 1, If Other Above
i Audience
Is
d. Permission b by pnnbtl b dlepov of she Irum dev Abed above as Indicebd.
Dale Issued Ire7p3� Retailers W Vlwl Slalsocen nmypa a
WWq Number +�_ Planar / }Fal , N
F renirythatmaremelarpf uedecedentidemifiedabovev edioo Oina=WOnce IIMtubummn M:
w Date of Chromium g u Tb Place of Diaposnion Y I / tefv+i
l fa sa )
Cfmmvd fVehe nwn4'1
SName of Section or Person in Cy_pe of Pm p We 8mN
w Spmture Title f mN
(mwl
Public Health Law see. 4145(2b) - 012697
Receipt
Human remains of ' I t defiveredon—. 20
Ft mIY�.,,. ,
I �
Yew Cemuwy Reprtsennn6 tFe funeral Mux'namNon duiL pemit
gfiNt FuvvJ Prsmrs R�g.m LicenwN ` �