Hays, Wilhelmenia Form VS 61. 6-8-34-50,000 (17.7901)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Dir 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 (/ 4f Registered No
yam, Town
County ,,6:/! Village - � �
�y//� � or Villa City (If city,give street address)
Name of deceased... .. ... .
4z7,,iip Single,married,widowed,
a Color.. or divorced (write the word) - Date of Death 19-3-5—
Age "2 P Years Months c3 Days Birthplace ,v
Cause of Death .
Certificate was signed by � - , M.D.
Address
Place of Burial (or Removal)
(If body is to be temporarily held,fill in space later) ,.��p ��
Cemetery �� " 1, ..�%---(/�T— Date of Burial 2,// l! 19-
(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 on the b ' they of I HEREBY GRANT A PERMIT o�
(Name) (Address)
the ....to hold temporarily and the body.
( taker or n having charge of corps ,remove or otherwise dispose of[state how])
Dated '/`, 19" (Signed) _... . ..,.....‘i--G -
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.
.9 Z
t•4o+ '.. d 0 a" F ~ b0 a)w O v 0.' '- to a) a) Na w
m ;U
O 4.4 q L. 4..,> n
C)
•
'' wR
>vza
> e o va.00 .idOd. ) Odi •O v cC� d^5ra, om�5yo Nu1 o0cl, 0. -dam o
Wx
d
O.� o . wN s � d .w„> a50a,�� .yv ` S o ,o y °' v u > 0 g 0 e
o.zOr W O, W2 mn E-cEs >, nnq o . ,r a +No " v Ot oO � � ,v � � oa °io •" air '; a0 ." 'Jd v . v � '" O� cO, y" 0 'ouaia �bC. NaS a �v :. y+ .. ° y
o aa °' �r ° � � at a wc4dW3 c � ° cal ECteYw" c o � u � adoW ° ..-- buy.ao ) oa ' ox„ 3-•N aa. � i� gxo v > o0a,
' y
...� ,, oa, y,u a."� m a O O ,,, d O y 4.
w v- O'" „ bo cd .n.. c y U a) O• w ,. L...+ ° r5c) GOa, U4 � •�.w„ a)4b' OUy0 +'q +.+OL.- y ;V .uS •v'... O po co ... tr, .-
0 31 • o , 0a-„0 N
Uanc ° UappG, •
� m 'a3 � b � t " a�� aX ° � � v '� 4i. �L �. p 4 y °)a° aF a) «
-ci
d
• Gdb ° — > '''.�'.-. i� > M ° i piy3v •�.b � A .7t...ty °) C ,' dQ i
V y � a o uN."
A '4O'C C rs m ,. d 4,) O cd
wa4sd'° .'-' .) W 'iE b° +4 a,, M>,> co s.. 0 ., O 0 0 d¢ y ,, c +a O � y, O ° v + y�, ' av Qrz dQ � p.0 . , U �.n d.. q ^ y on=.a-C• d0 1-4 •- O 0 s. a.) ., u >.- „aw
Cn 1:17, v.� '' a • wvb�+• �. xv •0a yauo m+ dwbb0 3OEa t dm� - • P w -O ua) ) ° ° � "QFo
J ' I ) �ub Nv ° .'' "ab a t. . bao� ,
,.�WW ' .-.w C%a .b. . Y , �YU6.8u .. ` . d1. b8v- ; u^yboi ,. ES'.+ v0_ OcdN W
O So wWHEo d � ro . ° wp " "aca a F... >, mca'o rn., c ,40 > ° Ad � .5, v tibuayu•° N atoguP NW a 0ti g 0S d > - a . a_., v CI a) a,., aUC
el
It. 0, d o . • ' N t 0Nv a au �o' u � wo Q ° >� � u� c3 b > � - wzu ,4o o u51
� c .g.5mu E4.00ua .oua: au—Am.40 7 . xz � u „� a . 0 ,.'b,.° > � wWE•1 �o Wa 0 � 0O O v„ cd F �•' ¢ „. 4..-. S .-. OU0d qv O �'± 0vi Q O
O v0 d44ZW ` � 0Z 0,0 -I.- ...-. >w;d L. Oa 0vpm.- ,.. 4 '5 v., t
' � ,3O > � P 'v d R oUb m s>., , W yI.-1 5a• .tl~ b b .O �0,0 , 0 ao >, `d � ,.),O, a>o a u ,: o.,•C' aus ,. m a�"1 o u& "OH OOQi <4 . a w T , ^ u » > ,. A c w4 .d, O- U,d U a .� ov t. p ' ' ,d+ o u b4d•yn O o c q. m U v > F •'0 Z ' Edv� A � � •o «S a) u3 yw a., g0b O0uw."-. 0 3 ,��. � v.. oq
- 0 E_ � �
0
r�V] C •7a ,. y� o = .q,, ua..a []u. cu vj ›I m • y _m ., .. � dNC ° yr .y "'4F, s C . p . O •i.� W.1w� � ro adZmU�O, a� m � P ' 04 ,+ y' > •^' vt400d a� y0 Q aEW 3 �.Va3 b y vi 0.- 'O' C a) wO a " � O , W
Qv yCd C MMop0� b.C ,I.--;� -.-a >•O • t vUC " U-5C0^ d `:U Um . Ou = 0 O U .o▪ � z� IIX �° A•a." 0., a � " ,' ^; „ d3upaa) 04:bF a.0 > ... c •, VC4. 00 -cD 4
Z V 3 m F pt, b }'� y "' 0 �'
RI o O1..' O 0 a v -t,- - O ° v y d.C'C.t OOi • y . vCO - y. m P. yO Ny`.O ' u▪ WOfi 0(/ O v � d > .. ° � � a
bo
WW NwF' , Mm ° 'yuab °° za' auFuac. a.� y �. aro0iaaaow ��g � z ,� o� z� o �. n0N ~ °. u. 4 •, 01ao* .c.2— a d >,u (:: o 0 o :.~'- U.� o u 7 , vO W V 'mzwW.7 d r.oa:^^> °s. No .'. O 0 +.a ad �'b O ~* u.„ � w* �aym•S.0•1o"C �,o wr§ dv b. "w.M.O'Oa0ac .u ' Cr'
E-+(/)
�r n3 pUW ..yay."p aO C .w s. a) a U o.t7 Z A 5,�. 0.4 w y,w o.a cd tid u O U I-, tv O 1. 'O oa =0E .o a Ors ,. I o ,.o * 4go." o `d0as.• o'.ic 04.< a
cal m '
ua • m � -Z "' 0a) w.5. a) c.'% e,,..^00r) -1 m w `aU .-.yp,3w.000Euxacd."u. . t, v0av - 0macd.d O b u . q '
W 44 d < u •" u c .V "d � Nb . u , 1-4� i °• •�^ 44,, c a•-• ,.. o O a)dt F. t 0.i w' " O . A0 N O > ti 'b , ° -^, N °�y y Q o0 vj^..u o - y ) y0 hy -- d Oo : a•y . 0 n.8 01 a0•O ^F u ... U w cd Z w ..
o a.) .- ci' Et)0,• ,-. asa) ad 4-. 6, 1: cdWQ1 .do d 3wp. ,,,q'udu 3b Q � Aa sv'o sy. u>'o o ya Q- Wro � O0 0OUv.,c . yao& bx � >,1.0 '. md3„ Uw °: a) 4-1 > ,JZ0k� `� w 0000y , 3 � av x0)000c .. cow17Q a ° " � � b. u � ° ° u u P ,, ed y � CO';. q0 Oa..)u 7 ,. kA a0,O U• -vtiw b' ° °ima vp' .� Oa •�" U 0 o' >,C tU O > w U y� 0 cd0 co •,
w iv. • z � y 3O ° cb tiy O^ rs0 Fa 'UMO ,.� C ° ',[Fcd� cd O. C • z> ro .iocuco .mt> v 1-4 .1)aorsCr3 .`� 'dNp -r H go,
mt 8l y Q • L - -d� ud '
u O " OuMUA 'C'Ot, = Vhp'pP.ER'o,Ery Hbn., N , a
W 0 E 8 QZ ' ar 'oQ >. -cu cdU '� . �ao 0Mx� OC a t00 ,.•OO a , abm7
to ' p_, ,.x'" O ,. >^ O.mr v . a.,.1 . :, d.ou ° . ny'. P,cd o ,„ouo .� 0u. uuVq4. 3 � w x:ayu .-° o -o >,u. � vro ,w•"Z ,„44o0 a V g 4.." .0.'.0ai °)- .O V o x 0 0 a),,0 a) 0 ,. boo O o) ,. 0v ,. ai Aby ,. O." . d✓+
Q A � ] p 0 3. w'w O >w 3 � O ,.'3a„ a. as �." aa.� m'CI..- OO',n ,.pw 00,4 Oc., 7., OA bA"
„ o,r,►4