Torborg, john C. IOUBEwu 0 VFWAFeverFarMErviGixFAIIN _ • � Burial - Transit Pernift
Bureau dViUl Rewrw
Rare rm Mud&r Lou x.
c rmw Mm
o.re�d omn Aa nv.Yra.dusnm.afmm:,
R"ofDo PVeem WeraB@s
Nazowo, SunwAdlnernuWnor
C .iwmarWl GYne iiY 9rtelReertss 1m PppeNGbre Fep GnMPor Rn51q 6ReMdlXelbr
vMaweofOew ® NmkQvue ❑Auiwm ❑Mmeeiw ❑wade ❑c emeorrc�. ❑rallmrR
MeeulRMer Rae rma
KarvaN Frees MD
Address
170 mm S.GYm fY6.raw York 1=1
woh Qnifinm filed DiAM Number aegiser Nunn
Ciry.ToworMilagg, GWe Four SWt 411
❑Burial Dame Celnmear,craway or Failily New
49ItYAA Pine VYw GrenYbry
❑Enrmbmem Admen
oCremmim mYenmuryT . awe York
❑O,w
O �aemmel Dare Pad Bengretl
ndror enworneM
OR roM mdreee
N ❑iranaperrr, , ode wima
a by COMM" Slli nem
caner oemmwn
nDwnremem om rerrmery Aedreae
❑mnYmmn ome remmaynmress
Pew nmwi, pglm.wn xnmber
xmedfuraral Wme S Mwr Sultlren Pmu Fv,wI Flom. 01�
Awms
4G7 Bay Rd.hwnaburY. Nw'York 12BOf
None of Funeral Firm Malang oliwsilun or a V vm
f Rumens am Sapped,n raw dun Name
i Address
W
u Fee mltlrm is M1WWM1Y 9ruFbdroayop of NY M1uman lxntlru OYNu' IM1YM pbonulnMIMYM.
Dar Y ,,A GRMveom Fepnradvmiswinlca Rodrn Arne E'enu eElurmnicu*SVII4
oh"o"I
Nord Numbr Bfiat Rae Glw Fell,, Nw,YOrk
IrmilylbNNe remainsmmedaewmiwmlreeaboteraerteMw'+d WinarmNwa MallMe permsmr. �r
oared oiew•iwn 9lgr la�Raea D�:po:iwn � G a
omw
w
ImnMd n+mmrri memrrri
x.medx.mrorwNonmu.7edrre 7�
'� signmre rme a �nRw
00&lsss lmNlplNz
Poblic Health Law Sec. 4145(2b) -. 014016
Receipt
Hwhan retrains of _ delivered on `/ / ' - , 20_
l
Fioe VicwCememry Reprexntin8 de fmreml home iunW mdvial pwut
Odnel Funeal Du im Rq. otl.ir<ve# '+ )_