Wester, Elvita M. 4 SLR
NEW YORKSTATE oEPARTMENTOF HEALTH Burial - Transit Permit
Bureau d Vied Rena
Name Fore Mieek War Ser
Elmo WV Ferree
F. Oalzr OS i raodu Irw&s
6W or Does
pled DeAr Hb;IMLIrTiluticna
Z Cn .TwnorVill 51"I' rl a5 a SNrt]Mertu Sara�eHwdW
F� Manrerrf ®NawoIGux ❑esixm ❑Hbniuh ❑mrm ❑GR ❑pv^mm
ul MeaW FeNfrr Name TNe
GNor,vremo Earl
Address
211 CnuG:lµ yakge 5giya, NexvvF 1pNh
Oaan CmTrmnhe Oisoin Numeer pe(NcrHmmeer
C .TwnorrN S aEOt �`
❑Burial Over l w(remlW m FaMe Nere
❑Emmoremor Wearzom n..k:.=
OCremTion puxnqury Tvm.Nen YVF
O nM
� Penp al Nit Nm hnnwa
F andrnr anerOf IHrN
m How address
�Tramweam oak %:ed
rvmmmm m
Carrier Rstiramn
❑wamamem BmEl umkrvNderee:
Remorse am rihhaWrveddreae
rt:mhlssudm =:uarea%Ter der
Na:mdFunerallbme W nFunnml HcmeM WaH9
Aare..
en Ave,CMnN,New YarF 12822
Named Fuseral R rm Mating Pispr5seq or m Wbm
l— Remain are Ship 1!%M1erlM1anRhvt
y Address
uP
D. PermleNan Is M1emhY9]mbN to ElapreaMme M1umen remains tleaadbed abeVeuiMiaMW.
Oaklssam ofl't]IYJze ge®sbardviul Sutin'rs John Paul FreM(EWMIcalOr Siglla¶
o-W:am
DrAnlNme,r earl Rare gygrryg 5p:lhpc NexvM
I anav NMNrtrem:n:au:ear.<eanieehmrdame.rereeiapoaead Maond.hk:dmmi.pe:mn on:
As—
Bmdwapeeon 4lnl4o nakoHuwaehon
MNm•
ri be
gNzmeol5eammpmmin UVFdpmnHa /M ww
SaImm ONE 4161ha
WH1555(WA8lp1d2
Nblic He ffi law Sec. 4145(2b) 012761
Rmcipt
Hama remmwof Lzv (Jes+� delivereJ uv� 7 , MJ •
�P m
Im Yc✓Cemaery p[geroptipgtln fima�lhomev 1 Jlv�itlP�B
Offiad PuvvY Ovmm Rq.rc lu'eoc p