Mason Ronald J. ~ NEW YOAK STAR DEPARTMENT OF N EALTH LF Burial - TransitPerm%3 ''
Bureau of Vial ReewEs
Rare FW Andle LN Sea
Romp J Mason Male
OaWWhaN pf 03I24 IlVtlnnd115I rePlr y
ROiR TIYwe WxarWtts t%e-A '
Cerhu or IIONiMKIruNubnw
[ ,TNvm orYrl ConrM Than yregAlartss 1tO CcuRy Rrub lO,CranN Twn, Naw YOM1 138R3
Mamwrd OeulM1 ® NarratCam ❑Axieem ❑HamNix ❑slgx ❑unmamirea pNmainK
GaumaWaxs Imes
MeairYQstiry Nam Thle
PA
PA
Art Ja..cn
mare:
1W Uftfffilale m Nrry VpY t]&N
Cash CenR¢ akrla O'uNY NvmM "Mer Wmw
C .Tcwnor Vill CamM I+W p1
❑Burial Raie fenettrv.Cremmaryw Fxilxy Name
p Emnmmnenr Address
Add PgeNmcmmgnry
reaa
%peremaNnn Mnmmwry Terre.xewvnM
❑Whether
opRemmal Darerflu.@mmee
F ane(ur andAt
N How Address
0
'm p TranapuNaaen use, sZgnl
o barter msimmn
caniw
❑Dimmesn P4 QnWnYAAArtss
❑Peinlemem 6h @mvrYAmrea
Perm lasuNq Re®artlwn Number
Nana NFArerel xxw Uammxe FwaM xwm Nc aMa9
Aeema
15Mnren Aw.LxnN.Hew VM I ID3]
Nmneol Fureml Frm Maxr�g RisyoSpenorq Wbm
t Remaim are SM1ippe61101hrtlun Adve
Z AOEress
2
W
G. PpmlaelWn Is M1ereNY granted so tllebwee of tlro M1lsmm remains a.wN.e etwva ea intlimebtl.
om lsmea pWlWApID nagimarol YnalSwinia Bans L Pe'es(EbttMiWlly Lglo
04"AmJ
owner Number ass: hae fnnrM. amyorc
Iwnav As rM remains Of the dmaem Ihmllleeabre were algm¢l mim was NS pe mm
Dm,f P:pnalun V1070 Kaxdoisput
wa
Bases n mama+:!
xamwax.mnn.�mnmma�Wd • �
NaMr
Brest Ll a� Tme
OOx's5WwANpsdx
Public Health Law r7&&Jivmd.�:
Sec, 4145(26)Receipt 014055
Human moraine o£ - 2q`Larcwc��
o W fq yyty F�t