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Public Health Law Sec. 4145(2b)
Receipt
Human remains of a , , delivered on _ , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
RAGGI Lot No. 26 E
Address 40 Lyons Cow w1' bu-Qr`t bk.L..-•r �1 {2�Dz( Section No.
Owner Peter & Rosemary Raggi Plot Erie
Date 7/11 /2014
Approx. 67 Superficial ft. Q
Location Bounded on the North by Chatham, East by Steele
West by Chatham and South 'by Raggi RosE NtA_k_y
Corner Posts
Remarks 760-402-7060
Deed No. (and changes) 3859
Payment Record Paid in full on 7/11 /2014 ( $1 , 400. 00)
Record of Interments
t I e R R E F/s. - 9114 I Zo 17 IA A T A 1`') ,
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Form No. 01 cJ f
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RAGGI
NAME Rosemary Raggi Age:
Lot Owner: Peter & Rosemary Raggi
Lot# Erie 26E Grave# 2
Case: Concrete
Died: 1 0.7.2 3 Interred: 1 0. 1 7.2 3
Funeral Home: Kilmer FH
Cemetery: Pine View