Jones, Helen Form VS 61. 6-8-34-50,000 (17-7901)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
W.'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.
gi .? �- 2_
Dist. No. J D Registered No.
// Town illage� /��
County _ Village (If city,give/street address)
~ or City
Name of deceased..
Single,ma 'ed,widowed, � , .
Sex /-L Coloor' or divorced (write the word) /v-�%' `� Date of Death ' ,.? 19 �\
Age ir--- Years Months Da s Birthplaces '
Cause of Death v1,-4.
Certificate was signed by - M.D.
Address
Place of Burial (or Removal)
(If body is to be temporarily held,fill in space later) /� -
Cemetery r/.. ..... ..... �.C--G— Date of Burial ---- --.1 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 th b is th reof I EREBY GRANT A PERMITto
��
, /Z
a:ne) (Address)
the to hold temporarily and the body
(Un aker or perso having charge of corpse) ,or othe wise di,8pose of[state how])
Dated c ,— 19 3- (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.
_, 'zHO R Fu-C ^w n^-.O I, C' I. w . W .+ I C'w CviF t...-. mtn Uu tow tn„,;y ww t.. 14 m
,nn V15. +. o- °a" O cd.y U p O �•�,�.0'.--' O `.: •F.U.�.� O a�.: O 0.� y +' O RS F F a� '� .+" .� `o-�W
_V .F O u ,00 'q- 0 "Ct
uy •� y O O., O ,. › , qw. P,0 y iC ° d .,..0 rS N b b03 y0 N +'0 w F u F..u �'� y F >> O ; &Q
0 �, (r?2� y� a0 � � v ��ow0-og ...- g -6 'a " g. ,, u "" °F' y >;.. a y:� EU 1-..- 3a'' b. ›.' L� °
a, 0 4 >,- U ti ▪.. c3 u.�.,,..,.� >,u_ o y F y cc�+ O y v, C) ,,. p y 0 tit,,. C' 0,a y;-0 y'^„ V vs 0
C M � F t4 '� > O� pC aaa� s..+ npUFb . F .0'"0 1.OSv
W W 3 tG.: O'-' y y ur O w F v,a+; ti w w+, y -0..». a.ti N u y u F ?_''' ,v
0 N .P v, s. ctl 4i .., v, a y O w M O ,.."•' �,,� :b O O O +-+w'd+� 3... a ur 4. F•".4 N y CI O..b.
3 w0 wpw • . byA yN0yUy0. 0,0Oa uuy, F ° 3 r Ub OOp y Cd yu £. •�l"D
«E-+ i .0 p u ti 4. 0 ..F > y F.-••o I,,. .. m C' u.b b0 .� u y-0�, 0 V y.'[+ tti u o.F
��,t /� r up « Q-d C(73 hiC ''�•' ° .iy1.l".%.°�'Cyy•° tcya0. ..,..,,,, yy„ .1. s;o•b 3F.> vF ° "0,., I" vy `�+a•3O
VO / 1 •qQ i� r"'� Q.CO'tiw t. >>ucda�i'^• wF". ° b�A °n.". w �>>> y�w.',, Vw „-,a� - OE , F...'. Oa•- >Q' aCa`i
' c. aF 40 •� a y tdEEF_ ,... FF^, .._ Oce Cnc3 O yfn ,,bu C'.: d t3.0
�J�,t/) 3 �- A z aI Q V y�;v °'��.� u a•*''�' s. °-d ',�, `' y is •x a d y&-) a-� w 3 Nt)0 N"-`d o '- o y r"-.,„ se any+-c-0,s.�+› •�..�.... «
.`�� 41
\ �, • ,,,(7 y yam+.Mi C~_,, 'Ei C y 0 Imo. 0 O.Ly ° y.''�, cd u `�.q N i, y a..S'• ♦,��, p y ate+•y j".O'•C N m ° 0,.+' a C°'w.b•a O i.'Q•C
« C� u y `n y.y+-O u a) ',,X u .w y nt O O uAtr, 0 w F . p.. w v,-° O > p .O
ZWW ,. ,., ,,, . tG ~i,,. ., �,,ive. o,ss., t~V U c 00 (1"q° cuV •'F. q Oy dU c) aycy.Fv �O y u'al �; 70
�� a u > u.4• b a o u °.- ? F k i d '� t, a - u ay'y m a".,u).5
`t"o p0°0: E..t;,� •-, , ,.., u N' �;�... p .+ >,> y^... a>•. ,n 0 "� w a u 0
�� \ F,•>r O O.L'% 'n i.'b cl ''+ c3++ C' M u y i, o„,, vl .. Q•c' 2 >� u y td... y 0 F p „�,.w V1 5
aiW'� E m0 H c3my yti n � 0 ceut T y t t7 ` p F >+' � �i3O � OS > Fy «
WE4 .Y.� u a O ,..� a�.OyF:� Fuv 'nYFy .a u .., u O F - u,_.., twCpl. tw O z
tit U U S•.. .+ .+ .+ .F y 0
o f 0.".., y.•+ 0 u w.-, F y >»- F �„,Tf 0 .., 0 u u p 0.... •0... > bO z W O
WZW ,c4colz �dA � aaa ~ �� F3� by a>~io � � � p�. y tx -yoy� w wC).* F �".,., cj,5 ° N � �'axwoat
a't�t~•t1 � 0 � w. q��� go � � ca� y > o � ty" O � "o'S��. No2a>' ",`u,y.4a'....p =°. 0 Cd ° 0ouc� ° ,v °F"O0
O'y't/� V=•O �Ht E~ 0 '�'.i'ti.n 3":�y•y�."o 1 v•4`,-� ,0i 01 °' y.-,•§ 3 F 3�,w F ai 7y tc - 0-4..cy F g.. 3 `C o E 5ei� «
z U•7`� a•la la 4t. ;i0UH t~ Y 'i7.-0.0a, F. 4. .000 d50 411 y_, b .. y u0OOw-= uu oi.-c `n by 0•u G.y.^ uV]Wa, >'
y 0 t. > U C y y•Y u iE '0 a+ > t�C." �,n Q' u s. u ...�'' t. a'.., O u a>,'°O - rt t. F u ,n w.�,.� y 44 4.1 0
H" v 0zCh40-41 ►11 a.-'y c, •v a-�o8 -.61'�n ;4 m-• `" ':°00740a ° z � ``4'by n °.- o'nv 0.01b,.0copv34y FW w
a V.� °'i. � ►Tt sd, p � m sF4� 8,2s) a'°o � wca � uA F.a >a;; �o c7•`ygOC"iFNy^ � aFiv+ C0 � u^[ QOrtrO
�J'44�'+ .., w« C �y, O s.,�... V. O am �, rw p O 0 • O u Erz a+
W"'.'Iri a 0 w 3 W_O H o y.+ v' 0 `d�' o U .^ cFs,_, O a' ur d u y w O in O•'� ~ u o y w•°: .-: y' .0."�..;,[ 0: E-, 0
CA K. °'t+M W 3_'•C -[ F E... v o 2 .s6.0-O.0 O y u 0- y b0 , F ro v, C' m•y v F-.0 F `� > W`08 'O
O 8y E.y ;Li ,0. 0 ^• m•0uC'b.pp-2iC Z-, >O Py ieF . m.+ ❑FS I~ y.-.:.1 . km C'•.. 0i y py Oa.. o a' r O0SF
,t 0 io F i.'."° u °'. p.... td u cC yo..,- - C).'d a� .....0-. rn a -�` Q z
IL( (0.4' ,. 0 „y+'Z W' 0.., "-4 p O w iC 0i... �. u '' v Z d u *• u y F y•,, r, �s,... u, 8 O 0.'..-. ct _'o w co F`q. 'Z�`�
O W C «RWw y tin O Y cF3'-. 3 C°',�', 0 o 0 ctf c°a-0 Q �* E 6.5 g d* 0.'�'' .�.0'00'°.0° p wt.' 0+Z°.c V I,. IV...,m °:b a' ° P,`C-O Qitl dal
m tC; t-, v. O u bA rn u.... > .O ..F u Vl r~
F,t p y E••t > e-.y'-' E u u,,., ti~ Ci o u-[ O^ C'.yw 0A ns'm m O a v ' to H u 0 �'i -v OLL'•..
F/s iii >HRa V oa - 'wE.cm .- N•b °;ua,°• w.� ,9# .51 0.RO ° umo.� v •-v0.0 .n ° 8o2cnF'y,� �, aa,< a,
`-I,�.," 0 �, � � �w... s~ cu u�i. p 3 O p >, ra3 w 2• 2 �y uo 2.0 bA co O014 u.
O y Y3ty. y.
WW bA-O yN." >•. uCu.a Ci 40. yU'O. tE.+ m y" -Ow tC 0w � O" Nt, 140 0-F s" p F,c,,•.; u F.O bo .4
s. Cd E••t., X Qua LI i•. vi.0 a p.+ m °'> cd F m O c3'^�. m o., u t•S in u••-, is s, y O 0
0 E•.t 0 u >, t0.+ id v, p y i„ 0 p o 2 a".-'.n t-• C' O,CI O.5 F,F 0 u s.... y 0 >w 0 z «O 0
WW 43g 0� u. 0•ww yu.+. ,,S ,-. udma.y a~ 0 ucd+' ti 0 a :+ i~ y yC7 i, u" bcg U A ro
voW �03 yu'�, tttp0 ','-' u `n''' c� 0. .-0.. 3 C�iMO ° uu�U >>ya' FI. . 'd « cd `n.8ov. M� O.F,F u O,a
s '„ to WW ° O •cayr . u..cy.Eu 0 py0.c 'b.0 cy F.F.0 Oa).+ .+ UC °' C) t..+-.+� > .°', Fw0 E+-Oetl y, r°.
0CA
w�-G o .a a°t u y "0• ao ' A ?: y tr co 3�+A'; ", - .nl-t o c•v F a0 o t'. c-o w k., y
u..r ,., O y.�▪•i+ O s. y u F w +-.'tC,j O '''.'' •',n....+ �'r_; F 0..-, u.0MI z�Cq « vl cs-o.F s~ 4,Z a-3,- 0,0 C`„i 0.~ 0 O v°I.O;�'.'+O AG OC; to ..o.„^0, u ° > Ow u u y.-. 0p u 0 y cn ,,,tw•t.°:
A as W�' �.� y o o c > !\ .0oyooa> v" >,°cs ° xN F n '�"
w .d Mil as ¢• .. ''^'n'ti o y y +,.z a ba' `� m o v M o..[ b0 M..4 o °a~'-v ty,00 fe-o a t, ....b �, p w x �, �, co w
[I-u . p nt WA [•tl0 az u ,u. 0v,.dv )- > C'." u`niO4F'+n� u;C 000CL) Cd�� y, 6.Od nQ 4),Ct= V O'.0 ,. 'O t.--, bOa CC' ^zC4
°� °D d� �Z qA o i 5 o o 7s F Ey•y o a 0 >� m.-, i°3• N ° a±, ; t, 63.5 >;E`°' u •a' u.� v, y.a a 4...5...E, p ,, - •Eh<h++4
A � a-� �tti) 0.0 3•.F,w." t,•" o•'[' 0y-F C'"i, �, a�i � •, ,-. 0ox.4dF '7, 1..,b0yco t. 0a) t-, C�j ca) yt. ^ >Z- yC'+ o
• o >w 3 P. 0 4. 3 a.+ ate, a 0, u... a a., h•d.: 0 0 N ..,.c'w 0 co.0 0 0.0 a, 0p'cc: .+ ch ..a