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Carmohan, Clarence poem VS6i. 6-8-34-50,000 (17-7901) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL` BURIAL (OR REMOVAL) PERMIT ice`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 DEAN,LEGIBLY WRITTEN IN DURABLE BLACK INK. - Dist. No. 67L//_ Registered No Town County._..�,,�� �� _.,. ....._, . ..-.......Village.......� _.....:... .....»»....._..._r.._........»_.........._.... - or City (If city,give street address) Name of deceased.. Grd�'1~ ,1 ... Single,married,widowed, 7.7 , Sex., . ..w..Coloi .or divorced (write the word L� 0 '°�-� ._.... ...Date o Death.., .�'- ...,...-:1�3` _ Days Birthplac Cause of Death. Certificate was signed by _ M.a Address- ..,. ... Place of Burial (or Removal) . . �°2 _, .» _ (If body is to be temporarily fill in space later) „ . »» __»_. _ _Date of Burial , at body is tobe temporan held,fill in space later) The Certificate of Death containing the above stated particulars, having been presented to me, 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 above stated Registered Number, and on th,. R ereof f fiREBY GRANT A PERMIT ofr - (Address) »-».e _.. Rio hold temporarily and the body. rson habia-charge of corpse) ter,rem e,or otherwise dispose of[state howl). Date _ »_29 ,'� (Signed). , Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No.62) is required. JAI • -7¢ p ���}}}i {S C7 C S� cd p pant p�n - J 4�t - 144- 41 �+ pj /„...i ▪ s. a� .11 ip ; :: s' ,t0. ©,�'.� ®m ay-a '' O w oGi -a�ya. J?iLIiIIFI1i O.,.• to a!"3V :" O E -.-r,`+'+ t,. -0 V )5 .'.G41,1 - i i gr Ih! .a � - -fib bo w uo•=av �, ' �. w s'a3•►. .—t ss'3. cd..0""i cats' V i.- I Q y- - tt' 't7--V R7 it ° y v VR.iro V u+' an V V a+" t J. - dui; ° tl.g I g". g. t,:w u o �'e++1 : -7 _ 1 �t 51 'O• �j,• RI a .�...-e! • a p.3'b0 -our •.r-t'1.• �.6dh 0 S} " ' I5. OD. Cl �c 30•au "#:` €i CV 0 a- ;, • : C'", - °°-w ts'.:[. .`*N Ck w C i._• V dY fi t 'a•. •G:."�3 '�,of .v C� Lr V+� m Q:V -...cd.:, 41)osZ 0.° V a+ V d>w • ..0,4 -y_ < a.: •Y MM. yQ..,,.2. - +,�•Y'V 0 O QI p ' s t-4 ottAl° y y.0•�- M '� 'VI � a3i #�;;. n1.= `a0 .:ii.2 4.2.§ ii V ° _ 0 go O u * _/u L'.k '.% x -.' - s ;'-A". " ,. M. � .fi:„.t...t.. -. [s s ��� � t�+Rr!"'�>Le6t'`� flo•'" ���V��* O � VH, * a5 '�� ;� �"'�caR3� Y ��"� �� �`�' cL, 1 <° tie p.a a: .g `st•ooz ,o 'I. '-t* ° _ � ., u- g- VOVI.'o - }.. w.�.i'. to-43 s, „:,. y..•.4 w oa '- ' " w. .. „ { < -� >-V °moo -V0.d � �°e ov y'wa "� s` p -a .1 4 f-. x 8. �.a*0.0•a....w�Q O•-•.� � �a �� ��`=y'°a a'.�o�`e"-���t�.» ��. 1 °4 bmi it i tS �•m °O '� Ci"i H"c+}S O"*': a ��u '.y ...`s�-.r � .tl'G' �� ^.:.'�y 'yg a. a o. .gr,0 my a�•� p OuG '54. 1 LLa+ talk 7,y ., *x•. ', > Bat p a. : y ++ C',_V'G a. O p,° y a.s. V... .q .�.q.w fl. 's -1'" >.A w v� O �+ A��`" Dww op'. 6�' >3 �w ° •-.�a'p� ca,>��?Zi: '' O.a4 +� oY 11Q p aao H e? a1 >u•'f,12_2- — •• .. ' _