Philo Jr., Bryan Tod NEW Y°xxSTMEOEPARTMBNTBFNFUTx Burial - Transit Permit
Bureau or viol Nxwa:
xzmz Fim Mail, Ian Sn
OMeW aa,nnm K If yelerm a us nmee Formes,
]I vun Warur Mur
Plxeur loan xnrvml mohuao,or
cM.lm.nmWTowr, Mren Naare:: r.W n...m.o�Nnurvrome Nmvmnlaaa
e MHnne.d°eMn �xMua T+me ❑P..mm ❑xrenma: ❑su¢ae �uweMimii.e 19=f1m
V [irtumrinm Ime
w Mee'm.laArm xm. Nag
Wmo ao.aNl crtmn.,
mem:
s. Iek.Wmy rmm xmvmxlxwe
OeAnoonm[wtied °'Wii[I xumkr PaVmrxumM
C0.1roonorVilade duommm Mal in
❑ eunal ONE Do*vaacremnorvorvxnrNwmeW.m..ary
❑ e�mmnmem Add,, a P:..vM.
0 cremeNon ry.xmvrex
❑oe,nion
GFxemo.d °1e ADARDTxeM
N Hold lm Memo
0
ZI
6 �lrempnMNn Dow
y ireircm
Dom BNenWn
� oi.im.mmn mle lomnrveeemss
�u�Mmn.m Dole amnrvedems
rt.mn mueem Brpeo-nom NumPer
nzmeul foneedxome 01443
peeress
"duoXer Rd.Ween6ury.Nara YM IxBW
meor Furenl Fnm Making dtpnllm or to Wlpm
t hmainsare SMmtd.Il Order Man nbrt
PeareSs
Q
Penrni"on lahwWygmnWtodlxrow OT MumxnmmWlndaw WonuIndin .
Dare Issued NWrWmm v.ymarolvnnslnlra: c -++%v✓w�m�• H^^��i' 9
rw+mei
Dined Noma. 057 PIS W,e„emry, N.ravoe
.nnvmnu.rem,mrameaa.aen��ee.arxe,Nmmmai�mNadm amm.immir Pem,xoor
Doe of Iiowsv. 9/71110 n«ed oisFo.iw.
w _
S xmedsemnor Pemonm cnmW vremi:s tr�v'1 a.a' 1
ry.,mr u
w SgnAurt ` lak W
B0N1$551W°MPId2
public Health Law see. 4145(2b) 014042
Receipt
Human remains of delivered on , M
t
Noe Yew Cemetery R,peeuming Ne NceM home wood on bueul pe t
ofirinl funeral Olremon Reg.or Liceox p