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Perry, Larry L. 77y NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau a Vital Records Name FrX Mindle lest Rr Nb OXeol @XA Age If VehnnN USAmrJ Porter B)Yeert Waex OXes F Fame of Death XospXaL lnXiMwnor 2 [iry,iwnnori r or Village pa Tom Sfrtel Mtlrtss I<1 NMM RUM Ory Twm, fW YM 1[6Afi 0 ManneraoeXM1 ®Natural Lause ❑Arriaem ❑Homode ❑mina, E]Dn ortdmn.Iw"s �Pentling adreen m.eni w Metlkeleemfer Name the O .ia,n smmreUry MO Address W Pm,bit obre Fuu, New York I2191 Mtn Qnmoak Eike o4lrcl Number Pryskr NumM1er Ci .Tovnor Vill IWbV 4`+ar 5 Oberst Ora (emNerv.VemXorvmFYifM Name EIEnembment pM Vlaw DrXOa tlress ®Crtmatim pK¢nWury T>.sn.New VaX ❑Dnn z One Plaxhmma O ❑Xnnloral mapr Xew ~ Held Address N 0 N ❑TranspaNtion OXe by 0 Closer R mat ti n AMOn Closer r-1Disin Om Cemekry AJtlress Neimemtem Date arremry Aetlreee Permit Issued to 12glmm�n Number N ameofmm,,llbme Brewer FunerL W+m.Ma Omis Atltlress 2a CM1UxM1 StrM Po M 5 W.IeXe Lumme.New YaM boya6 Nameol funeral Nm Making OisposXionorb WM1to f Alums,sare SM1i II DNerIAm A6we Aaareee M. Pwmla is ha ygr b Eleiwae of then human romwne Gaeaibad abnw as Kristiansand. Date Issued Reginrarof Vila)Ranks Carol Vadflandi lElMlMigally Sipm) NsvmN District Number 4M4 Plae Handed, Naw VOM F I remfy than tire Knows of thedeeedent P tanned adman were dispdeea a in amNamewilh u month on! INDate of Disposal J'75,gaF4 Plxeaolspon(n IN b ✓ unby, piW n [ol IC re �p ) A E' Lbery woman w Signature rnm CWH *55IWMP102 Public Healthl Sec.6145(2b) 012757 Receipt Humor remains or - '" y L . Perm delivered on _ ,. a Nor Yew('mmtmy PSVreuutio6 Reg.efime, Lo lmm�potu2nA�Fnmit O�osl Fuoml Dirt ote wittom#