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Rowell, Marilyn f ♦. 1 • It -l0i NEW YORK STATE DEPARTMENT OF HEALTH Buda! - Transit Permit FiaiiiiMPIVIIIIP ( mddie ill aik. q of t ifirallalaf pf U.S.lS.Armed . ._ War or Dates / . , Hospital.Reagan or ar �, � �, _� - 7 - c. ,L..,e Address � Undet�+ieed OPendr� . 1 s - of DeamskNakial cause CZ 0ae psi 0 • Circumstances cWe cf ) /oci - �• v ) a' 1 - y Addy Le 6 fo ' Q- . Filed, District Number \ IrAi( ` f- - Torn Date 111,21 C y . 0 ` �I 11 0 (.Date Q Removal and/or Held 7'QDate Point at TransEwrtatioe .r by Common Dew Dim Data CemnIl Address Q Date Cemetery Address Regishation Number ,\ Pena -Name of Funeral bonus N. _ . 1 - - ,<Y•= 6d 1 rye. , •5 II Lora- e* SI • emeensbrt iv_14. 12404 of - Making Cbpaehion or to whom .. , Remains are - •In.=• $t Other than Above ` Address ` - - is hereby granted to(Woos of the human indlaated. '` Date Issued . - y --.z of ViDel Stems - _ ' District peeing \ Numberof the decedent ident 'ied vane d of in adoordence+fit thison::• 1�y that the remains Piece of �M•c 1 o�i .. D .._... Q�"r i Y 03aadan) iii -ItLt(iat The pome or .ink ., I 1p(,S r• 111111tinit 0, (wave number) rf *Fable ----- (over)