Davidson, George Form vs 61. 6-8-34-50,000 (17-7901)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
`F This Permit can be signed only by the Local Registrar (Deputy or Subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No..,.! 4 3-7 Registered No.
-�,` Town
County l/� 4" 6 Vi}lag,.
City (If city,give street a ess)
Name of deceased ......... / e ,,=-,
Si gle,married,widowed,
Sex. ....Color... :1.`... . r divorced (write the word) ---t e..Date of_Death ) / 19...3,4q--
Age 79 Years ,,r Months .lam Days Birthplace
Cause of Death G!.a-•,- ,4/..kciVat,:ae.Certificate was signed by , M.D.
Address ,. -....... a
Place of Burial (or Removal) ...66tz .. p` .
(If body is to be temporarily held,fill in space later)
Cemetery Date of Burial 19. ...
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been pres ed to e, after careful examina-
tion, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the aboveve stated Registered Number,
and on t basis thereof I HEREBY GRANT A PERMIT Q/� / �'�
to ,� '� /�
'ame) ( s
the ��'' :x a�� —�� to hold temporarily 2---' the body.
:dertIker or person having charge of corn se) I In e otherwise dispose of(state how]).
Dated 4 , 19.,,. (Signed)
Local Registrar
Th Permita s sufficient for the Removal (and Interment or Cremation) o o y part of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Transit Per it (VS No. 62) is required.
'z[-4 O R y'C a ^w m^;6) 5 O u r. O O' O m 2.�X O a0V.Y. O O.i:.� cd, .q m O cd o. do u v O..•cy-° OW't!
�y.. O y ni O p•w _ N
Y W CA O. W I.Y 0 2. P. Ci'' O Y^ H w.O co m 4 .>N.�Y Lm.. i. Y Y °Y ° m 0 ."� a V
w W2Up Oy. w... GLgytoy � y. cdm h03YOy 'i.01- wQ 0t a' cda u3 qOw
W'�' m00 a5-0Eas >, 2 .ny2..o...., • >>OC q.c , OO E: O... 4-, 5�+ dal 0c.'cn m a. O
3 a ~ ' y � a 6. ° �3 �
b al. � odda o ; � y � yb «03 0.- t.. 'our .0 ' 05o• � ay
'-'o - 00 ' �. au a la .CW � [ Oir . aNcC Y wt7Y .. a � V �Y dO
V �
� w , 3 ... a o N o C •Vo -, cv „ o �003 u Y ° �° «� 0 _0-, .00u, „ oo
v:at i Q a� 0ba ; aa, 4).0 .0 aivp Y C py
�a ",E+ " te � •'. � cd yd1 Yy' .° ° . ' > b0 . mG, m4yYw y. cdp Y y
' .«>, •: a' b ' , . a' (., ° W ' p•cl° "C) 6g oyy• yw ay"dC . x a O
y yC, ^, i .P Y Cp , °,0 Yo
.-, ° a-
d dW
3
CA OdC W•+ � O 0.. m•., ^ CC o � y �,Nc0 vnY ryy bA> > OO a> 63.0 • ►•4 .CVO "A Q ►. pcw0 y '. p y. .. pa3 C C. wOm . el•
q � L. > b0 .C•.. r, • O m O c-. y nyb m y >,.. c ay «AJn1a) y'd.", °Gy.Y.. U " ,4 b0 ..,fl. o a'. yr .yy 3dNaY ° y'sa) CS Y -- �O4LE�I ry � ., .0 .G o w4., mV (� yiNy o3c Vl 0 ......00yO• C 'N 0YI" oV V : .o w HE-I 0 •U = U ° °.ect y Ut.N VA., y,." V w . -0 . 0.:• waaw -• p+.. AhZ w
vs
EN 0
a4 H , m y U m CD. U .Cm.5 .Syy"-, O o U p 50 Ad.OL. m b O > `o -d •7ZWW .««14 cJ ,,.. .na.,4NrtcoyioyOCa, .▪-O v > ` ",- yaiyg)o '. 4iy" yOv . ay a' =: .ao c ,. y Oil S C ^A a : a. -, m coy Yw a u d► W.
/ c a . or O Hdo y r•Q., CxO' °
� o x �° o "" �^ v •� C`I .: wo° m c �> y yy .. y ,. ,-. o . k.v] 5
QO m . o ,,,.- corocov ,,,, 0300.> ,.o ,., O , , ,, z "d > o �- g
g.[+ .P :b cq' �.~ aUp o.+' 'P mx• >'. C0LLW Oy wU o ,. bc, m 7z .'aW + .~ � d Ow ° � y yy . Qy y , C 3 a
Y .H a s+. P, o ° iG , C - Y• y oyYcd : C Cy : Y C CW[~ _ ' .�.L n
o ' 04 v w -C p s~ O A O y ° .-, w � yrw r � aa Z W .m Z `o ° ›,-0 - 3 -',,,cr.. 'w °'-4' y io .-. - co .,.., y C A",-• yC ai N E >,'i w a,- ma yo •3 u oY O a . ° pPedis N �y, '" ;;NOs
Q ,-i ` 9a0`" I-, t. yOco'b y � o , � cd y.Y �'� y a, N' ' -, - V x y. yO Ov ' 0 0. � �Si Ycd e,.0 mUY Y y.0 ' > ,. O- U w.. p «• 'U y 4 y Ysq - 0 . r : u, U . .. «Ox( V,,- . O P3Y �+ .4.' o •� mUO 0 w'YE'•Cdyya . .- v 1 C o . 1•: Chy g 'C ,. , � ? ., d-, yA,-. c O . V44 ' C ' a' y cd6Tv ) LI) gU /.� c A O r-c i.Lp 0 b'N'd.m y, C"-' cd ti ' ,a mZ ':N, Cw ^•C C3 ''.0 m ,..>= c .. g id O OwW�i+.z 0-I F -�',u m cN, >FUbO ,Uy a ay'p,F• iyam m-' 3Ad. ytimy;.c- . o
•
d' r-; a'Yp UP,>,,bpm• cy.Y ° ,AU pi ,. a' a0Z0 , Q +vI oy > ° mb ya>, ° uv po -o � o ' 3�� CE�W a+O .00 3bn-4 •oN �':, c oo �, o, ob �E,� E p0M,iWa -v o. Hb > o yy Vt0 , c, cd � , O; a
X � v,y '« x v ' Uv O po � � o � n o ca L , d O ° ., yc, E7 " aci� � ° C � > � CYe n � •. � -. i v0 d00y- ca U� �� ...x.4• uWZ� � 3u ps ° Q � i 4� x fo y � � wF m '~ U m �W �A a' ▪ , c,V)O 4... W ° O � y � 0.0y6' m bZOdoczC -la -oO m .-- ~ Ob0%Ny..., y", 8yv P y y000A
;Id , uw,-+FG. u co0 -- nO a 'agO , OP• .m ., 0F, °' Oy.;� sm ma,. a P a mO mb AO' cep NO�NYz ° " ^vy cc.'," ubopx4yy co ° ° o x.�, y.-- ' , o= o 0Zyr o ,�a°w . z �w j- Z ad �wW • � po�ti >~ F > ° y off bib* 5�. a v b>'a 0 g . "GVm . roU'C po 0a' ° ]-«rotOto�U S:> � '4 .i6) 0 0c w* E Cy* a,-'r �p.a p.acO ° Z ci y -C u (n 1.4<< « O 4.1 ) .� > .i y O ,O a O u. �� . •rN.�w0.0 cd uc tdG N * Us VO o 'CCIaifE"{i-I `JyEy .. y C '0^ P.O y. ° .0 c3 Vo ., ° O O -'- a ri.0 8 Uc e � -.F., `s ay"'� ,--C 'U 0. - ,0 o sp a) o .•-, y •• v,.0 m rY',:, co 0 ,d4" ,a ,. EZ HA w.0 .bqy ,-.T ..q'c7PU^ ' m3 VOmy ;'+'Yp,
' yw+�, i2yrco . U•a." b o ^C bAniR.. - ro.ai
� OD
AE�. .CO WWW « :C' a"' >' q U3-a:OO ° N O'•>Cy' oo Y x m .. er. °4° c3c . .,OYk > E'+"( ,--' 8.p•iY. °.5w y «OdW - �"^ >, •°ya � mO m b pg..) c-PNiy' . .�I. a• amd ,,y yyb y yp b0,. OC 560 oa � � q.n"w cut'. m � C ,n Z o ao b04 y y = C y. � d ycd. m� ° � A C� ycO E"y
oW G ° ° y� a°Yo ° o� "b- ` .ma° A � myq va ...I. cc co N � 3 T.- g �� oeWyWyO av � " ri 0 a - ma1) ° Yu ° > ° ° y~ ag6,
a .0 wy • y. , eC °o . 00 �. 0 ° ,Q «
)i 0Z a�X � NyoC �" OaWC O ) Ymd > co7 w a
•
oM • ; Cg'tO , Oc ' - bO bd ,00 E . 0., bJ .oZO d 0 E. aQ • bti O �y y id N y.L m OM U z U MC a ,,,, EOa0 d c ."-y � >� Y (n [ .a.a MzY d ��by �W m0a'AZo'- �' °'� ° bo°':- �� oia. 00ao ° oSa°°+. am.� o . . y °�' c,� ' ° I.
oo� :ywx > mY 3. w , � o ° ° 'Adaot � C7 °� o.o Y °� E '. y oio w � y•.Hy .4 e 'b a� aoy'dm o ,:•;: y um W ww �3Q .�. ... O � Py3 V. y..0V, 0 „gOOV.0.Cyp o � y OO I.. CU y. V CUy ,. #... .0 v 0�-.9 •-•cnao •.„ •m0 >w3o . aYaman. y.. aaYmv._ o'� wowodoo .7ab ,. onAoa .,
a .7