Shippee, Eric M. � 10; i
NEWYORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Pennit
Name Fan Middk Lan FrcM ye
. CM1I a Sel
Date of Card) a A$ nvem..nmusamee fn:re,
We
CNcareca 4 MYae:a warorlNp,
Place If eath Wapi:aunGtlufon or
pon.Tewl"Viu (Norman m gremaee:e,s Touklo HMvmY.Cwnm TmlT,wwyp lm
Mannernl Dam Nnural cause Lj Accident LjXornlnde ®Mika L]DndeMrmima El Pending
cnPmmnaa InKrt
ad Medial Cart Name 1Me
Euav:Xep eMa C.remy
Address
so AkMeffir Coml Helmem am New York 13yN
Ram@mrnte FIRM Di,lnn Number human,Barber
,Tori am aus
❑Final oah @mNetY.Lremr.'y.e Faifmxame
FlEmomn
bme R/Il Nne Vlnw Gemelwy
Memo
®De malion apene gTown New York
women
❑Pemoral Data Plxe lRmueM
ari andbr Neal
Hold Address
N ❑ranspnnun Dun PmMal
is by Common Shipment
Gamer Rninnon
�Di,irm:meM Dare Le:akrypeeresr
Remainder mk cememn AMM rt,r
Permit Issued to �alrnon Number
Nemeol Funeral Xome Bmrer FuneN Roma be
Address
b Coach PO Par Spy lFke Lumma,New York lamme
Name a Funeral firm Making Dispassion
area WM1om
k- Remains are S)i Pact II Other than Move
Ammeo
w
C. Pamlealon is hw y gkglrpd CO elepon of On a human remai n deuHb" above as andiwlaC.
Dale Issued owlici Nagai Yin MM m, arena L Parit(eeHwniaa rysinned
}
Diann xnmb<r adv PI:e CannN. New rmk
a:mv mM ue mmHn,of me xaexm iemnrea adma were M'�,Pnsa m'�n aearema wim mIs armb on:
i
w Calem C'nno,ir n 9—a-doze Pt:emDi,Po,ir nOdd Y Auk
N
6 I ml g luns,,j gercaurvb:r/Na nt m W�
M,mw,Hml
w Swourn hm �✓N � row gI
i
DOX-15551N/telpto(a
u
eet Law sec. ala52b) J 1 a 013
emmils of delivered on , 2a
Represemmg me tmmm home amW on burial Perini
Funeral Direct Reg.m License#