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Galvagni, Norman ir• if ..New Y ORK STATE iDEP,4 R-71,A ENT OF HEAL-H T Burial 7-.11 Vital Rer;ords Seolion 111 - ansi Permit ,: Noel .40 t.-,--_, v \1e act 1 0 r nl I an / va_otiv , Mak. • Dale ot D‘rath - Auo , 11 Volorarr of IJ*.j.. Arrneli Forces. I 3—c. C1— i 6 1.9 .., Will IR DiRES V CilV . 1.-i Place -a eath Z' e&u.spit I Instisuti,n q I 1 CO 1 rik"r1 Of Warr'(Dr) Lak.S...., :Srifte-I Address Nciiicom,... 0 ita Man - ,,- i0 ner M 1--ifta""'yj Natural 'arra.iscr4 7 Agnident FA Hr-,mildde FL-] su,cid.„ L.] Undeterrnmed Pending 41 Circumstames, Invef.tigation 0- — Ili tit,6,:itc...al CAe.,11:111,-N ,,-7-Itlatre i 1 n - 1 Title 0 Kik ..Se- I 1 K (dr. Mb Addruss , i L0,101 Lai_ NY '., °earn trficale L Fled L Disbiut Number , Pergister Ntimbor ''' „...„. 1 .,-- OL4(.0,.... ry 3RAW lir VII.ilfjp c), nci..,,,,,, -- _ :ery or Cremator ' ..7 ria-,.frial - patf' 330-1 DLrirnmtmier,i „, , . ,i-tflfirrts\ XCrern?Mon U ikans b uLn34, , 1 z Dat.'1:...., PlaG(.. Rom oved DREITIOVA aridlor trield anticar - Address Hold il.cn I,'1Va0a)- DDate Fetrl 1 i Sme nt::Corm-nor'::: tri Cmetery Address Deslinataii n DV.:AlitOr In V2fft Cp.rnerery Address 11 IH,Pffilv(Iller4 ''''':' POrrilTi14.;;;54'fb Recisirotion Niumivt,, , NallikP Or Fom?tal Home t /kr -1-utelbera I OLQ..., ,,,,, . . 011.9 . M 1,.._ [ AtAii-OSS - — — 3D kid 1 ark 1...hitie,& Ny /042_ N_Lim,..„ ot F LicieRil t rtn Pol-Ltkrig jitipcKotior oi t•.." V.'llrirn *,.... RfiMilIFIS are Shipped. if Other than Armue nilmsYr . a AddteSS cri P .! II' Permission is herb granted to dispose of the human r sins described above s indicated. t . - Date issued 1 af f p Regiszrar al V-ral :•*Erafistic.2 JA4 ,.. .12) Co - - I PiaCe' afritt dl,a).4,, / D!,s.*dir.1 Main bill' (9,05-- , Ag97 t_176e4,_ _ ...__..., , . ,. . .,...„, _ ..._ i 1r:err-Ay that Me, remains rd the docedenr idenriLe.1 aLove were disposed di in accDrgunce with this perry"! on. 1— Z Dato ot Drsposttion 3/31 //1- PlEct,? or Dp‘-...zug..,i-,v:i) Pal 4... Cr441110Prii.. UP Ch..... CC1 1.:7-1 rurrz, ,, •i ttit Name of: Sexton Cr Person WI Clilir:. L-..:,1 Prerntses ttrs-0/it irkikj-- 1Z Fec.t..10 p,,,n0 1 .] Signature , lif T r..le .. i:ovar:, 7)01-1-1S5S 10212004r