Witterell, Lydia I I ! I
I STATE or NEW YORL Forms II '
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!BURIAL_ F3HFRK/11 -17.
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-.. (Dated,) 2(461-"z"r-4 --- g' 19 1.I
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The Certzficate%,f Death having been fur ished to me, as requir.ed by the Laws of this State,
<,1 permission is hereby given for the Burial of Age 77-/-/
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E (City er-riaenra0440) ettirws t7
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c. who died at , in the County of ZeciZzrr-4.4.-- !I
on 116 a/7../C/6,-- 6 19/ t the cause of death being-6.4/Merizal'S Ofir-44-44
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2 Place of Burial Ni4-1444-44-43-440- 4 1.......4„&i,7.,
Undertaker or person , AreAvtazitiZiel04.(Signed by
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L-- • in charge of Burial c . .,
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Resi4ence ' giZT—cuts Lict-11,3- J a (Official Title.)