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Vines, Kathryn B.
NEW YORR STATE DEPARTMENT OF HEALTH Burial - Trap$ eP rmit Bureau IT VIA Records "HoHo Middle Lann e.VNe¢Rush Ag 1fWanan a Ul Armed Fortes.M IWYw Waror Dales r Oemn Hospital lnmm�on or morVH I.Mau Tqm 4ReIHtlRss Ba Mantin RM,Monau TwR few Ywk lAtl aomtn ®xmrauu,e ❑A«Wem ❑Wmeee ❑weednlfenx r Nme TBkame on nAddressne Omer,Gbne F9p NssYss 1=1 nxl<ale nee DoWns Hamner Warner Number wnorvill More a uses ad ❑Burial DW cemekry.Oummry or Fxiliry Name �Emomnmea 0ulasruM W'e Tq'^Gnmawry Address ©Cremd0o Olmms:ry Tour,New Ym Donslon O ❑Rmwwl Bass pMx P<mwk F and/or aneMHtld NOW Address �hmamnrbn Dm Parna bymmmon Fa Caner DenllWun F�OisimmRm Door @m q"dmss FFainkmxm Dee @urekryAeeresa Permit barred us Re sswo,harbor Nameuf Funeral Home M8Kwa FunmlHmf.SouMGMm Fel9 01070 Add,,, lWM...81,8 users FNk,New York 12803 Nam of Hoard I m Means DisposWon or as Whom h Remains art Slansed.NOIMram AWv I Address W u Pow isuch Is M1eraby granted! rotlwpow olthe human rxntlne EMwtibatl above MR lnEiaNtatl. Dee Issued OB2VEW0 Rugimara Vna151Minis ISEann MC fate(Electronically Boundif Hie/ Diann Number 4W PIu Moral, NMYM I RrmYmnlneremainrmeeeaaeemmmmm:eanoR:,eadiepoaeaa ioaa«em<e.immie pamnon: Zz W Deka Disma?an R�A�� flxeol DisEo9lon u/ qW Q pelAr/ lMrvrttrr/ 1prcmwM gNa awmnnr mm�in n �� e. m IssyiaNR tIk RANdsssl07AOI p l a: Public Heallb Lew Sm. 4145(2b) �12752 Receipt Human remains of \\ , �f� ! delivered on y` l7� >. 2A O Poe Yew ccm �l Olficiel Regexonee�fwatlsode�w"' 1 Pmutl Dirtgm Ree. Lk X