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McWhorter, Suzanne
y ,' NEW YOPRSTATE DEPARTMENT OF HEALTH ' Banal - Transit Permit Bureau of ViblRxnNs Name xm Miaah Lae Sn m M::WI:Mar RenWe WMOIRMM1 Og IIVe4m NLLSA rtei, CLPtlaA Wvwrt Wvar Ortes Plaeof RAM1 WspiOldm 10 E City,iavm orYill N SOMRoeereu f0 M 5Lw4 N9yN VIIGga,New York 1IDRe w Manmuloeam © NdorA0'm ❑arcdem ❑Hmiride ❑molak �unanaminee �kneina rlamAertes low u� MeeialklarYr Name Aallmos He xv Yorke 1W Peak St G4nae New York 12b1 R y.T, lrae Nlel ee PAnANumFer P:pAer Numhr [ .iowor Wl 5]50 >] ❑eunal owe [emercro Cremewrvarixi4ry Neme �EnmmM1maM wl�Yom ce Lrenutry earee XQ Crzmallon OueemMyTawn,Nw YnM ❑ %ad ZO QPemwai Owe Nchlm.N F ardAn sodMr Hel y Hold mda N pTrsns[slatim Owe Pwm Of by Common W" 1Ae CamN RAina0.T ❑o'�nmemmt one uwery Aaareee �Reinmwm ou femercWMeress PermnluuNlo alonwommon Numl*r NameAfumal Home M new Rurrenllb:re-kq/Y Address 123 Man sr MMe, Mery York 12WB Name W Funeral Farm MAN onroallun or Whom F. Ranee:. ,Slopped,It Caner than Amvz g Aaaam IX Panniaeian is hereby 9randaml W mepoas c Mea human remains ae tall ad al or a as lndinabJ. Owe Issued mPO%t2 m Fa@Aardvwlslar0a skaeyxd,Fm^npcG ffyswno tw l olrnn Numkr nW Plae ARWU. Xw Ym lan�hmnlne:am:nroraleaw aemixmMae me.we'iawaeamin aMoma:w.xnmie Palmnon: 2 one m cisPoseun - }1GrG vlxad oisPns2on PaP 07,A f N m W MNv/ MmmMeq kavmakrl SNn:::eM kwnwhr¢n � l /W*evn w s,sne�—� t rnla WHa5551o11181P1o11 Public HeaWu Law sec. 4145(2b) - 012768 Receipt Human remains of "l�r JI, delivered on ^ -� � , 20?0 Fine View Reprteeolmg the manna bonw oemN an CKfi al Funeral Dirtttm Reg.or U=