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Schempp, Donna Marie
NEWYORK STATE DEPARTMENT OF HEALTH r Bun P al - Transit it Bureau of Vital Records Name NM Middle an Sax mnm More BGNem p One of door Ag Nveteranotus Armeeforte:, OB/St140Y0 WYmI Waror6Yef F Plaeot Deals Houfisinnitmionor 2 Croj"norolisfe I Senn Address GI¢rn Fsh Hwpbl wMannerdamh © N.wraRarre ❑Addmt ❑Nmidx ❑wIdN ❑ana�¢Iin �md=,n bn W Medical QrWkr Nm The G Gen "W" MID Address 1W Fah h GMn¢Feb, Nna Yok 1=1 Learn UNT,,*Fred Oistiai Humber M1gihrNumber C .larmarYdu, Gams Fall 'soot ¢R �Nhd One Gmnry.Cremebryor Fa isY Nane Ermmbmem UVEKNOm RMwry Grertmory Address %�tremmm� awn¢eury Tmm.Ne.Ynn mnm Dace .m;m= Inuffer bM Ad MI F� jW ion dare Printed sniment Deninadont Dale �m Dee GmrertrvAddress to F@n�Numberral Home MBKIImertunsFew %W.GYm Fo1s O1mBres DS Msn St 5 GI¢n¢Falla, New YON IVAN Name of Funeral Fro,Mating Disposir or m When t Nmainsare Shipffess If OBertlun About ■ Address 1C W Q. PaFmiaYen Is hereby grenbad bo dtapow of MBlauman mtnaina daamfund abman as lndicmbd. Dee Issued waFVrDxo Hard urara VM1 smAnb Robet ArAeW Curtis lElttvonially Signed r=Naaai Road 111 5601 Pure GI F&b. NI YON I(entry she ON mourn done dttNent iRnt&Kd 11I ore elapsed d in mrdays xM His perm'/Om. Dose Di¢p¢abn �i W n:edu¢pnnan nr�l d ad An o Qi ad 8 Nameof�"NM,in[narde remNe¢� z /✓/ W as Sgnnure TMe DOH-15551m ERpldt Nblic Health Law Sec.4145(2b) Y` jb,,J �t Receipt Homan remains of ,�.qa delivered on—, mne YevgmMery Represennng i c Nnerd homc pddal Fwml Dnr tms Reg, oe Llaen