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Thompson, Lois A
NEW WRKSTATE DEPARTMENT OF HEALTH Burial- Transit Permit1 Bureau dYul Records Name FiM Mieek Ina see LdaPTnn eon Fere4 Oat✓oum Aye nvareranmus Amed norms of Ram Bt vwn Waror6rts %add ONM1 1YopNl.InsMuemn C' .iwmarWl Abunl4l®mATvm 54ed MYess WmmnmmeMbssl linter Mannerofmam ® NamtMuum ❑,mean ❑Wmdde ❑miade puaeemm:Mee uPemelne clrtumSansf Inren MaeicAufier Name rn4 varaw:Mmw 00 Aaarcss 1WW,m&Hoed Mwnt Pmma Tmn Nw Yuktww CeaACenMeak RW OiandN :W610INumM cn .Toa orvAl `M7 ElBunat oR 2nMY.CrenNPo:ym Fsi4ry Nwe F-1EmombxM W1mMPa PYmAwcranuExy Address ©cremalon psreWry Twn.Nwvwk WnAun &mow[ R6 Mahm�md anerot an0/orHe1° Hdd Amms w ❑Trans moll �e pdmd a bvummm H card:. aedinnon �o151am am Tmmmry AAereea ❑R.mmm.m ode Unwery Address Pe mnlsmMm W®maum Numbs Nameot FuWmIHo e IX awe Fumm Fe elw wMR Andres ] Snmmsn Aw.CwFln.New Ya 1M2 Name of Fummi HIM M flv gOispe0h,Oem WMm BemaismeW If Omer than Above Address M W G. wnnieMWn is M1ambY 9mnmE mniaTwx wme human rwnMinN Exwiba RlNWa xitWinmtl. Omismed OW07 M 0.uimwofvital Aminlcc Shan Mamd WeAmiwllysn" /+immel DIMdNumber SW Rae V hom. Nen'vnM1 I renHamdmeremansdureheh:diemaFmealvxxreeiepoaeadra amxameannaaa Mm,bnn: W oarempsp Bunn S/11 tm Plod oispsuon f la�t6V roumrq �NrNarl / Namedsmnnrp inOmngad niaa ee.!�/ (rin sBnMnre f� rWe WH+ssslNnalpada Public Heallb law $ec. 4145(2b) 012741 receipt Human remains M delivered on nnev CmnaY l Xepusen&a tee fimnY bama nLpmu dmNPonNr O�eul FuoW Diawn Reg.or Limnetl 5