Hayes, Vincella Louise Y NEW PoNg5ig1ED TARTMENTOFNEEtiN
91 ar.a�mvilalx«nos Burial - Transit Permit
Name Finl Mime
VIONULmomm a Lazl 5«
De"Death pgr, If veal of lf3 among Fpea% Fenye
06ravrar o rl Vean waverDaka
pls<ol DeoM fool msrilmion or
INCil ,iownor Vil GlmafMg
Nnu
W Mannerolpealry Strenaince Gbns FtlY Hwply
amoral Caux ❑ne<ie<m ❑xantWe �mieiee �wxl<rmima @< nngi
W ha lCmr r Name umslaxes � .g
Inon
O uxiu.laav, Tm<
netla. AO
1 W PN 6t Glen Faka NexVW 12W I
Nam F<nifeale File
CnY.Tom Or Vill GMe Felp DDIsnngNUMa pgismawmM
❑Burial One Cemele ClLro Y. ryor Failq Neme
❑fmumemem Ob1ra'2060 Fvy vlewcnmMy
pp Demob. Address
xm,von.
❑Nnm
0 ❑ Femoual Nk Flaee hmpa2tl
mi amroram
y HOW Weems:
0
m �FrnponnM Cole roimm
6 becmmmm 511
carer NOMW
�Dieinnmlem [We CemekyadErte:
❑Famina r p"< c<llMnamele
Nrnilssnngm
Nam<m wool Nome Al FwemlMnm xgimamm mrmbn
atlemss oorei
IPoBMan M.Warm, Nx VwX 13fl95
Name W Fuaral Firm Making Dismal or WM1om
1— Nemainsae SM1ip 61IOlMrlbanWMe
E Udirel
IN
W
a Nomiagipn is lrerepy ym"W to Elapasa Of me human mMalns deamil abowu lntlinsprtl.
Do,mum oanlrmm Nry'NarmviWl5laemes am..rvw.w e>.FC peram,rm¢yy
ml
pinnnxnmxr all Mae wen,Farm. Nra vom
emih mam ma loin OF me e«<eem WmmM Manor Wme abpoemn OF in«mmam<rin mis p<mli
r
w Dole Of pismaRon 9 Ie pU[eol Dlywndn
w /auWa
N
pW ro ie
z g/lSynnure TW �1
/ a I
M
Wx'6551MWBpmli
� I
public Hearth Law Sec. 4145(2b)
Aj
012706
Receipt
Human mmainX of
h 4F ) AetivenM Oe u
Plnev fSOMy' emMB[M fuoeiel home v+mMpyn� P�®�
Official FuneN Wecmn NeB.ml.iameXL�