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Merritt, Gerald I . 1, 44- 7 6,,t NEvy-fORK STATE CtEPARTmENT OF HEAL7H Vital F-T.ecords Se<dior Burial - Transit Permit .. . . _ .. ._ . virni",. '711CP, . e..7, t,.:41,-:,:itt7- t Ertit Sex 1, . M c_r-r Date ot Llt,totrt 0-sy.?„), 11 Votoran ot U.S. Armed Forces. ao (-3 -ro \N„, di Dates j\)a_ __ , ,,,,, , ,,,..,,, 4. II- Flor...:e T.1 Death -,t,spital idstitution Or ,21 CitliCtrKsil-)0' VE-i13170 SO()ro or\ alrf1411 Aft:ire:SS ct.9 a tor,5 . Rd ,, , -- t.,. ri e 10 Manner df Deillt.. E Natural' all1FX, 11 Ac-nident El Hr.lnir,ide FL:j Suicid Li d--er -id p.nding-..L._1 blij----- -- - - Cirnt;rristances invn.Fitigation til ve.T.f.,,a,i c...L,J.ziiii Nairi,., Ct axe- ( i Nb Addr;-.....,.s:'; I nd t an 1-0Ls2__.K. N Death L„ertfic.ale Fhed qhct NUfIli.14,27 Pey--ster r d" 00, \7_1_ 1 S(.10 ; El Ronal altn Di ritombrifent h , :ifirc:-.•.s$6;1 1Cre.mahori ri„Riimovai —1'14 1- 2-1 - -C( uLaj r, rille...lery r Crematory . Wye_ i e1,3 ere kikai-0{II/ mac: -it-movotil tithtior field i 0-4-1 A ank,:or Address hold ,0 Date Fu.itt -;i1----- Tr anc;froftartnr,L-. „..„' ' - ' 5 ty.)1 -....orrnion Destinalidn Comer - . ---1 r ,o e Cemetery Address ri Drs,.riternik.vit 4-- . 71 Cemetery Address L j meerinet It i I i - i Pcrrcht 15 ,-...rod ro Registration Numb4 Nama: or F tin4?rai How@ 13 InC.,,kAYr . A.„.44161.ai VAL/ inc 001.1 I ......_ _ . Address CP't mutfch a Lak.sL. LLL Zja4—r1-12 my / ,: , N. o or r urwlul F-nrri Makr ig Dispotilbo o ut vj 'vlat,f,r!--, ..... Rilrains OFR Shippiz.d, if Other trail .Annve rri ,..... - -,. Permission is ere y granted to dispose of the human r mai describe above as indicated_ 1 Ellie Issued 11 2.) 13 Regts'trai ot Vtal Statistics ___,, AteLs , ' i Dislrin7 Nirrnhi.,:o' la,3 PLAC:C"-Tuon e)S- chr--.o. o.11)._ A) i nortrty Inat 7P1C, (on-lay-15. .-:f the docedon-, ideltri,e,d at:dye were -thsdased ..L.11 in accord-dm* with this perrnr. on. Z /1 1.4 Da''.0 11:4 C3-spotAbou ii-ic-t3 Placc :..e. Dt.-..,,ow,-,r.r i g...ittta- (14.--c.tdo-N 1110 Ci0,.' .01 t ICI Narti4.2 Q Sexton r... ersor. in Chrge r,t Prem.ses U.I . (p:WM_ „trik_ Cover) ..-",:0H-1555 :02:2004) __________________......mm................m.