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Cleveland, Anna May
Permit NEWYORMSTATE DEPARTMENT OF HEALTH Banal- TraOSd Permd Bureau of ViraltcordsRecords tA,mW Fm MiddleL:a Ian SM Me Damaged Femtlef Craft P¢ IfVAennN US2Ow MYrn WsarBusesf Deathorwn or Vii JdmWu Tom eamvo]er NrM Oeekr010emn ©Natural CauW ❑Mciee,n m.ix �Unhrerniima �Ptnaiqcmamnmas mWl Cartier Nanaulewu Becomes, RAddressMl din M,bnmNq Twm.IMiYVF1ffiS9Cendiatt Fired Pxji9Nxnmlerownot Vi rbNCM R6 ❑Banal Btle Rmelery.Cremamryar ittilis Name ❑ einnmbmem oWrermx0 Mnavi..crmnemry Wash: ©lremNvi OuesaMry TpR New Ywk El WnM O El DategY�12� F andbr Wartssm HowON Qlawnrof ransprratinn whhi O by Comma Bmlmet�Disimm�mM NthmareryWdund Permit NcemMry.Waress fraud Decade) Pe®nRudr NumMName 0 Funeral Nome Abnd Hansmodes300 MM&n9r,WenmauqNameof Funeral Firm MakitM1om h Renews are Shi II UM1 f Address CE Q. Permission Is hereby grarrtetl N diepoas of Ns human rearnadiduce deaCrlbed above as indioabd. Date Nsuea der Peard"cavail Mnisnrs X.MCmac cons fiElrnmnlcai oN A", Duero Number Eels Nato mmGlemt Nm.Yor Fi snip con Je rzmains N ere aereeem ieemmed abwe.rere e i sposse M in aeardrae mM this w owe of oflPosnbn 91Isl7nnashma,omh'mn ,comer w � o-mawr mamni M.a�.n. SNameofsNmm Rrcwm of NMI xsspMr W slgnnure Nk Pan DOHiSSIadhat a public Health Law See. 4145(26) Receipt Human remains of _ ._. - - delivered on_ - -, 20— Hoe Yew CUKta Rtpreacrulne lha lunuW bom oc amctl on bunny Olfieial /^\ I'nneml Directors Reg.or T CCaSC#