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Grimaldi, Anthony Joseph NEWYORK STATE DEPARTMENT OF HEALTH ' Banat - Transit Penn,17 Bureau Of Vital Records Name nest Middh Last Sn Mlnm Jm muNl Mele Dare of CealM1 M1 Ag IIVe@nnolllSAmlMhrtes, n 1 00De B4 Yee Plare WarxD@f laed iM ; ona Cty.lom or Vanilla 6uMpaFaYN SawAtlaw, to wwsuen Ike,.auu mw Feps Nepe.Ner Vul,tadro e Posner of Mmn ©Ndarat w ❑Ayidem ❑Residue ❑wNme �wxamime �Pew'IIM W firtumsrm[es Z;�jsa W mocad Offiie, Name T'pk O Wr wp MD Lldrtss almpNe Carta.Gam Was.Am Yok 12MI MaM CeMeare Fki Dimrl NumM P®'IMNumlel C .Tarn aN SSAn Glen FAR Vllle 14< 10 Brad AN Cemeteryu mammary o,faca"Name MEnhomhmeld Address esss10 Pare VIA Cromaby ©Cremalun GuewuOury Torah.Nex York Andrew ��� Ms andl rNd Hold Address Daft b QTran eartarb w n tamel a WComlmn Sni men Cyder Mstinemn �Disavows Dan GemekryAaaress L1Ra.anmen Dan Mmdenmere,: MrmN Issued Ikgislalynxumhr Nameot Funertl Nome MBNIImn FuneN -S Gbm FMW Dion Address 136 Main S,S Gam Fair Neu York Fill Name Fumar Fi,m Makma OisposXunorto WMm PdressareSH 4MMnerinan Alwe mares Parmi"W W hereby godal W diepoee of the human remains dseMlbed above as lndiw . D@Issued 0124ID20 Pe ssumfWASheislio ShmaOnome Kelleher(ElxtraMddly 519" epwwel Ustret Number 45 4 Plare W mh Gmna Falu VnmP.. wxYu i anih mn the remain of N,e eere@m ieemsea above rrere di.Pnsee of in xmNyke emn mis ce^^x on: Daheof Di,pa,Ninn tW lm Pl:earoiePn,mm� .I�.u / Or gName of Seem,If Perms in Chug Mims X w fw5 no 5igndare Tnle FDN-1555(MM)P1Ms Public Hea Law 9m 4145(2b) 012772 Receipt Human remains a Miwe on p_, P V Cemeby R<L eoMnB Je funvnl Mmevem-0pLariY-pencil OmnY Ponttal Reg, aLk # J