Fuller, Nettie Form VS 61. 5-24-3 5-25,000 (17.8593)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
IIPP 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..5-4.S g Registered No 4'
j� Town
County_.»».g . .. . .»» ( .
If
,give street address)
Name of deceased..
)/ Single,married,widowed,
S lor_�� .....».......or divorced (write the word)_ ».Da f Death�1r71- 1,3 - 19.3`f
Age 7 0 Year Mo ths- / 3 .Days Birthplac - -r 11
Cause of Death
Certificate was signed by.». » ». • M.
Addresq __. ».»„ »»»» »»» ». ».»»»»... .»»...» ..... .»»....
Place of Burial (or Removal)_. »» -•.»„.. • - —»••-»»» »...». »» —
(If body is to be tempor fill in space later)
Cemetery --- .,*•4.---•.. -- 1 ....Date of Burial .. -''- .193—`s
(If body is to be temporarily 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 o the basis thereof I HEREBY GRANT A PERMIT
to...»«»» (Name) ( ,
csa
the....— „.to hold temporarily and..»».... »» ,, :. the body.
d aker or sop having charge o co (I re ♦ or otherwis pose of(state how])
Date sot
19 (Signed) � s*»» Q
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation? of a body to any part of the State ject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
{ Ft F� O 4 f.• v•C7 .-i w N.-i'd �' •-•• ,, �+�•w , a a.+ , v w-= H O ,..-. V,y v 0 ►1*g.j Vl w.F+ M L+ya M 75 w W
�1• yy (d R a . C7 . N d.z= c6,5•�.i '�°� L� �• 0• d f� d••may b i+ Q
F.1 O.i. v O cd O df ..vi O ° Id•z.•..2-a d 0 •-••.� .. ..a y �..rr i�M i+ 0 Vl xj C M•5+ O V
pa ►..... O>op �,,. 3 =r4W..-- ..Qf coal - >r bA O ►• �.A r. :d u.Ccy ayiO5
is. a ttii a°a0`tle ...„,. 0.00AaS'°w °.mac.0 -4.0g .N �� a �av oc Y � ° 3 vo,� �' �
« � „ a d a; v >� a off' v.. >,
.ed0ca W' . . -Too�•°8o".«+9p"'°may o4 °'5y°'aw a) •o .g- : P-- Uua" u >+ v dOd
Tzl � 3� cdospw•m ,,, vNva� Oy � Dawk *,,...� "dp ,90 .+p0•R w ►+ ,,OO� O . d Z'O
d 3 w ++ 0 % �...54cdcy ° cdv.uvO• t{ v0 ,. v u .. •Q cd vr.,.. .C�-41000 ° 4t vv Z. •►.
•;Q' p.0 Ow 0 y v..' F , a ° p'v v Z .0 v 0 b 0 0 wx
tX . .IJ
Q ' s. >, ' • „. u , bo� �„ ,, bo›, ',,.,'Cf u m... 0 b p c6 y i. cd N w O�d O+-'a+ i. t., >.u �' u�'ate+iC p a °.0 O'Ow >'tu. cd v•.. O.-.a, .. p... bot�. '4"g 0 u � >.O.-' a° p ,. 'b ,c A v t;�d4 ,. ,. .a..0•.. cod:-: j-i •r a dn O 0N >+..,• o ''..wv+-• O >iw'd - ,. vim. vv ,. .. v _� .s~ vv �uci•� Hvbida. Op vvvav „ Gbc6.+' .� «0- bu .x ,. v ° o. d Yr p
ci ._."7 ref H� �b vu'OOQ,0 '. 5. Owc, Ouv4v'.•` 44, "-Qy� 00 .... ia) ' �•, Odu .d•°p ,w� « .
-43
l" 1.0 d tv.. E-+.b.dcb y Z 040.v. v 7::: v ,. 073" 0 }*v.A v S. °. y.. . 0 5w 6. p'> .G O. H
z� ..,,. ..s y. . c'�V a'.r 4 a ��"id SASS 6.Y 6 ..t.- 4:1 >. I'i v,c8i .^; .°,.- a° ,.. m i.-0'° °.0 Q`� 4)0.: -- .A.1
z! � O �.,p2 � aC) m � yovyv ,.'„ o0b1.4 :~y b td ,. to vV am.CcpVUwwvy Q •l ,. w 0 E..l• Oy,>,y AvH...'bm,OO N.. u9_11, ... a� KO-, -vi,;4y.0 Q, pSwRw 5.-4-' "-
c CO 00 a "�O x•...u,.,,v..,+,, w':. u y, v v v ,, O.+ N y.o cd>... u ti'
4 < O w++:" v v v ,. y'0 cd cd ,d V ,. V t,•b d•0+;..�.. - �.v �" ° ° •� F'4? fd•Ly - +,v•++...
4W . IP. ,§) O ,�- axp4,-..)
O.0 >~ vyrn.00 0.0 , . • y•_ a.0 _0b '"Obi `. -0k, L'
* H v Q O.. v.+ cd +' t..-. •' cd q " le."
+' >~.0 v rs ► 7,.. +' A7 O it,O
fW3a�Eia 8 v a w z cn as - •-• 0,..0 �3•a 3 v y� -•� °�' tU 0 71.-v�' �o rr••. v " � ,.,, '' � ;'°~ k if. flit
a z r.w E.o.S 4 •U v�9 °.2,0 2,'" v > d~i a w ''0 ~ `n ,.°N a i-O 'V t •--"' �,d a
- . . w Z„r O u•5 >'m 0 V ZVs 1 .0 u.0 r 5 _ y p ►►,-... . w 4 u^.w� •-' or-O u cn_.. Y:
J
v. 0 2 H eir
y rr�� o .�- �aF.t FI CA .'U z V > .+ +' cd -. > t. .0 v,0 Q ►'id a>•0xQ - ,•,.a All �y p`t• V.�v..id:.1 p.`n.d p' a+ -N ..Aj E v.,. .. #w H d �0 �•O ► O�• «~ u L ►' .,w-0,-. ,Oy 0.' 0 u•N v'd 5 ' at.G O..G >au - v�c�.. 00 0 c,45-..Vim c%d ►d wO u Qid v!:1E"Z•� W
I�• °' ►r+ off•►= `d ►' � 4:' a.., '., oa of - 4m ►.. ccd d8d eo >
W 4 a8 6. ►. .. �'O > aw ❑ ► > v vw • O� v ,: v .. O v.+ 0C0la g1
v m O v a. a+ O y ri.,, m y ,�.�y v... �•-». v rn.+ w .d
Z w la" o cd... p v r t.O d.0 o v u d u bo N ,. m ,. �, c7 6 0- 0 0W
v ►� a w Tjr-.. ►i +•-0.0 0 O- v"0•"'•d id ° > ►.'cd'' 0 .ei..+ 0 yv, u to y V V. a 0 o v 0 v a. 0 v O OG C
E•i ., d v.-. 050 •OZoala0.., m cdEyv OAT~-w• o, v a gc .9•ntioa 2
.-Z � O
W� E-1 O " u'� ° o.,,� s. OM6) 8y a , -A= v* ° o. ° � 'T,'., Copra uOS 0ocd�.. �L+w
�7 i rn •�,•O d ►. ►. V 0 0 v -.r y+ .0 -0 v.°.. Q 0 O 4 V ,Ui, S'.' '. c'S •.. y .+ '{it
�� «m�7�.A►+ V1.00 ., cal.„+;w.'OOOtdar0l. ,°'.*. ScOi-- v..-. ►.* a+''cd.5, 7043upg8Z u, u0.-R �.O�.tiva Q..u, f/J ►v.
E" N 'O T.v.P d 8 > ,�, . v' u ►' V w y y O u.. y+td ►" u.0 ►.''..5.p 4" 2 g', cd u cd:p.m '++ u ,, vi 00 O•A a►.+*0 CG•S
'' i. a++' C aOC ► ►, 0. .�� 0* up. >,w n v v .o-. ° cd w d
�s d ,'Ou O , cd.w 0...�,i cdu4..« O.b ° ua `"'Ono +4 cy Cy vcdy.8 aimacd ,, mutiyu OW ." eQ' $'
> u w aS ,, C7 u u . m w H u w .+ cd.. u. do es a
Z yOQ 0.56' Oaiaa? 4 vuTlid O.G cs jo yrcd O P. 13 0 f Od pl~id.ld,° F. by 20
4 • w0 E�., w... v v w v o or•...+ O; b cd 0 w vi v c6 d •- .+ F. ,,v O d
(j��i .� ,,.d ►. yo.�.p.nd.. y °'S � cap.. v,.° 0a:_ c "_o, o a 0 I.. Ca 4.:. •, 0td.r.'`�., " ►.
Ki a c6 y^..• O u ... td. td m 0 0 y ►• v `n E P. +,p ' v ER cd y ,'0 ,. v 0� 00 0 0-0.+ N
cuW Qa (i ,7 A1.0 la u.+ >`p•y w.0 v u N• ,.A... v•C ,. L O N box A,.i u• 0 v-0 r cd N > b, cd Q.4 u...0 o E
4�4 b' -4 InaF X y •ygtd2 °N7e:� a+ cdawy .' vv Ou.0v ,.- >`.y,.0 Oxtic.=-.11p 0y0 N0 ►•w+-• > .u. OX4 es
S► > � Wa►.c ° -5atItncd.C.SE-8 ° °, ° 0a .[ vy.0 ,. I Na+9:° �T.: Z,O•gg, Vt..pas..4ab'0ct NM
Ca. t. ty... aowaQ� p
A �$ ncyd•Cg0" -.41 °a►dGarx0bm' OvR'O..COu >>�•0 °00•y0 ,.neN�A�Oa+O.x � ►dOOV1-"Q P+H.•
_ O V by O `Ziw �•. 3 w t7 .+Opv > ti ,• cd - cd.G 0, h , atW S!
Q• ,. .0.6,. utd vq m0., °. ,d.d„ tw b. ,. a Ial-, cc dNa00+' ". •s
W _..z w fi
Afa O d LL Q ,°C.v+O.""°.. 0.�.. 7. •••C..�•N• •vOid `tencit c~d 3 y ,m, v(0.'-' u ,. .a•� v. �u:.to�,vv s. u a.�,; 0 AO
A ypt�t �v4o•o 34 w'`no >w33o ►AS. 3a4a'ga, a08 v.49Qc.'•gy•0. oo1;). e,,38 8 co ::MN-0° S. oc•bOZ aE-1