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\ew York State Departm~nt of Iiealt6 1624y1
y~n Du`' ~ OFFIC[ OF VITAL RLCORDS
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~ 43a. SIGtiA 1F OF UlIDERTAKER lEGISTRATION NO. 234. ADDRESS OF UlDERTAKEt
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V. C. Wagner F. H. , Inc. C-2553 (o - ,~v`, 1
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ANO RECOROEO~ ~
FlLED
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UC~I
R~ VuRIF ~~LA~
162
8~1~9
'6i DEC I ~ ~ xeturn to-
~ Irene H Wohlera,
,~o~E~~: ~•u~TR~S 31 Surrey Lane,
CLERK CIRCU17 COURT Plainview , N Y 11803
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g~K16y PA~147'9
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