Langdon, Louis Form VS 61. 6-8-34-50,000 (17-7901)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
i 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, LEGIBLYOlt
IN DURABLE BLACK INK.
Dist. No. Ol/ Registered No.
Town
County Village
or-Eity (If city,give stree dress)
Name of deceased , /72/ ''-' J014,.. a-7i1,1
d Single,married,widowed, �4^
Se�/.u ...... . ...Color... ...... . or divorced (write the word).. ... %•- Date of� DeathL������ � 7�� •..5
Age . Years t‘ Months .. Days ,� Birthplac . �...QA.�....a
Cause of Death .... .. .t y�Yl n
... . .. .sr'z:....'-Cr
Certificate was signed by ' .ca ...,� / , M.D.
Address � - �K
Place of Burial (or Removal)....ir) �`�- `,.
(If body is to be tem ri y held,$fl}n dCemetery . .CX24,, x,(.. ,.,. Date of Burial 19..�, .
(If body is to be temporarily held,fill in ace later)
The Certificate of Death containing the above stated particulars, having been presented t 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 otnthe basis hereof I HEREBY GRA PERMIT[
to
( ( dress)
the........ 6. to hold temporarily and the body.
( 2.4.17 or perms.)happgcharge ofgorp e,Z �( ( emov otherwise dispose of[state how])
Dated .. 19...0 (Signed) e. ,:44'-,'._L ?_.,.
Local Registrar
This Permit • sufficient for the Removal (and Interment or Cremation) o a ody to any part of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Tra sit Permit (VS No. 62) is required.
I .1.).o.J z� O ej p A ° ° � O N. ° z p ° c 6. o_o w m �V W �`''"' � r' p cd... �' .•, 0 ° .� W
° ° rn w y ° m w i.. �, 1.71
w14) NLc. y it..,..,.� O °... O �.0.0 O ca O UvO•" O 'bW q 7 yp a rna0 ° ca ° o6. d _m bA3� °6. 0 � w0arc ° cd 00 i.
O .r ✓...� d a'0 ai 1. ,..•, ,- u d c03, �'*' a0i�'° .0-Cy �.N es °• y ;' ° a. 'O d O v� 3 a`i ~°� °' D, LO'�"
C4Oai >i^ ° ypcdv.. ..+ a O- oy o . md E..•.�.• o^`" a) 0 a0+•inc.a Np.a'•'0Y Oct 4' t,•
W OW 3 C 4, ,..0__b0 ,.,ao w^' C_ Oa.. 0,0p' P"" ..., ,-.. v qp ° TAU yF �t7p sC40
rYi ui % cd c,,,0"" rn a O O O y,•'"' ice". L. c-,..`:'. O O w'U.� 3.-y • a m ..Y ° 01�0i 0�
d3 w ww'y, .+ bDca �'•,rjNcd ° � ° °' ° o1- °� ° O° ^• ° cd..� ° c-a -0 -.", ppo.. py ° ° O.. ° -sz-c.
3E1„4 ° 0O a ° ,. ,.•ac _0 � ° 0�•o p ° ° ° ° ° ao .c ° uO•N v a � ,. c �
p4 �x > �b IAOa0. o , id.Otyy•O cd ° ,. �'% . nCO� UatO O rF qN �a pN� cd � �y M(/) v�
vO �.W q��' a oa �• o ..,,„ . ,.. ,,, a°i . o � oy , ,.. , • 5b ��o � 3.c b ° °oa � a ,. as d� a
�Vl SAC ny °° 4p; �+�• A-- u � �' p �.�= aa, �? +. oN`ay � ao ° ° aaj ° a,� ..� Qd
v) Aza � °•Ly.-' a� > b w °^ ° AY•0ma 'boa ° N ° '" ° „ E °' > -7^-• .'r)
zF q] Ua � o dunwp7-• ;;b� o is e.• ''' o. at a� a� � a� � � Oy,g- V. do0••-, a,OdOm
"Z :� dv o-..,E.� a, a, ao.b °.c °„a `°°� L' °xacN` w ° °�_,.yad : .� v ° off. . avw:bn o� `A� o
z W W� �c «�W �% v.m u `')y �m-0 -• v ov..,-.d b.,m ` ° u ,A:.-..-u,' `„° ai° &.. E 0 E o ^� o o ca 5't' I" '"
O wW ►" 4 = 4 ca caNu,v°y/ `L" N�..00I • 0.Cp ° b0 cb . ° aM ; l' ;,°� Na qua o
v a ai o Cc4 E•i••+ 0 a> °...`,' v�� o u N a.R. .O SS 0 . d.�.. > y'.0 a s, a +� •.. cd ° = 44 a u a,W V)
a W yS' c°C l� F'O a� ° c"'z3 a^.o b 0' 0 a�y m,..0 0_� �,0 "� a.,~i y�•� alA'° °.d p.0 `-'y , ° �w'7U o s>'• 0M,.00 > m 0pz.Lzt7.
aW t'w (� nco o Oa O.� . cd :a" ,°.y0 RSO^•.C.y x .4 y..0I, L M ° 70.y Ocd u.Oc y" °'" Q4"W °a
�„� F4 dz yr. E: a.0 is w 3,a 3 m I• "� ay'.0•..'.c a'"' 0 " 0 ca `" cd "" co o 0 y0 ° °a N w•m x'O ,61.
Q ?� .°. E. a.' nt 0 „ u cad c. ° - °o > w o,0 uw. o. a�, 3 y ar d q 0 c' I 4, cy u °.mac ° -' o� o
,►yr !U "..4 O1 G `o cc, a' ° y > «i.C!'y^, °.'0+y, L• ° vi,b ,� O 0 y •0 > ".^ ca."0+ bk•-..0 0 ° O 00 °.G..0 'n j ,.. ° '>Cl)H"'
((1 0 • 0 m M F p'.°,a w.+17;.� p a ..b.+- O v O 3 v,v-, C a, s, a)^w.b 3 O VJ
z ATV 0.4 z .. � F. L a u ° .� a. b.� a �, o... � �., � � �, ° ° p•.. ° a �, m ,� � ° ° id 6° °u' �W x �`
OXO I,, vadd,F Q.Cv oy ?u a)gibb > a.,•,-.Gd ° yid G ..zc � � °2ow uP T� 0n ��� �'uN . .� ° �,.awip
F a~ v • v di °'a ..e.e, W a 3p u m,y c'.o•� o'3'co N �� ,�•r•E 0 ,:- q °u... Qv � °,-, o ° a.)1 0 c0 g •0 815 3.r p oul
[� " N 4J 0... 'b.')° y .� a cd ca ° Lg y 1-- ° a
Icy)
zr� :94 oa3a: u F s, °24-; id `y OCIa Ate ,... -5 }+.Cd ,,* 0 ,, ° E;d ��% c0d L., g oaibcd � > u.y... A0U C r.C• F''T.+[x••, 0
V�" ar b� a,� MI
OY 4••C,Op.N 0 E. ° •b..`)..0= o O a) 0 N �dty�,0 O O m "'o v bA .N v.9, cod,. y°, vvi•C `� N G7:� C. m}'"�. W""' g•
8ti E- LL, yo o °V ° 50,. ca id Vi F+ ,. °-- rn K a oN °. ° ° 3 oa.'
W z ezzW' O•" N- oo.. 4 "a•o � 8) E 1)p d•= ,* gl, T4. 4.>,-.,� °,.• G� 89,P."� cda°" a� aA Qa
0WU ..«�Ww ''' V] °Ycaa'" $ - oo8cdcud•bo ` * a0.a b v* ay' .0.n�o.n2g6EZ. 8i to.- ' O ° o °0 z'dw CO al
E,•�.+•(/� d [„� >y y°•.. a 0 °w r. ai O °'q -' ,. • .0+.••-0 w A p 'd'in m ° a,n 3`*+u s, ° O id 'i. '4 c• ai a+•.'
Z2 �` a >HQ . Uw..1 ..,,,e, ,'Ccd ro �.5,., F�.". av . 0 •.. . 0.P.• 04 ° �-.gam° bcn cn�,v° a�i0EA 0 • roAQd
oa ° Q u O.0 O >, ° a'.. e. cd•'"Ti..,... I. E~ hd 0 ai:cj ca rl y,
W W m-° ib `' v0� a,aa ° 00'tl.cac�a..id ° aN'' oo� ��- °wyca ,, . A L() • ° eo° o a °
C4 s ctlH. it a 00 a p i cd a' ° cd dp o . v -,
" v) v F a cd. a o a �. °•� as �,C ... ° "O 0
Wa •
u o LEI X v-' c0ac0d �'O�.2e ,..-.75 QA.Ravi•b `°w',..,�Z7oa` g',0. ya'"i °.430 ca °•av '" N >b ` ° � cdp�.' OdAO
i7 � � t3 WR, ° O •-GPm . -.,4 y O oNGoQub,L° cd � 0.C��+A.OtiP.CIM.'0-. bQcn.a:b° ° u) CI le.ca' ce'+. ac. ' ° L.'° X v"'c el
O " .qq ao Nu � ay.a a ° c. cd3 y .°H ab a ommoM., m
C1•" +'0.' ° 0 °;.d•�, O L" r^ F. ° ° C 0"El� y ° •� p w •N S7 b,0• 0 a... o,� ° .0 d'O ,.. W...,,,. w
A d a�Wa . r �v•-. o mZ a�w °a° � °� °Oa �O > a°pp�yn m.r'� O'. Ox °id p ° Oct. vl dM,q
w .�y to r, 44.-.•�' rn y b t ..,.y y g o_^[.0 .1-0 c>d C as h O x ti .-- v o n 0 a) cd °W ca a ti�.�cd.G o i 0 N v) a W 0)
z O d G as "�, °v O � > °'it.'�, m °0 OEM O 0 b d 4 I-• .0 o coo w 4, .0 a E a 0 U m bU+ y•bA ' 0.5
W W m.tl G,Az mA amv 0O- 4�bpv. � d� N'y# � 000 ° Ccd aOo � .+ ,. T coo ,°.�.0 u.) C �yb °ar bAa° z
t7 o a a.. ..a cs rn v ca 0 ,.
a d C7 L °� 0.° ca 0 ° a� ° oia ,. ,. cd 'N I. °.o ' ° 0 0,b '- ,., '6 b U o ''•E O aZ m
A Cvai.. r•� 4),... ,..:; p.0.'� ° °� ,.,0 ° O .0 00 °.0.C ° 0 '+°+ t, b'y 00 c. 0 ° �, �° 0 ° y°j ,. .�`/--, c�i•T+ O
�' o >w33o ,. 3 a.. av' aa u.5a.a.•• .'•a._ 00•in ,..nw oca.0 o ,.x,' a'v ,. oaea .., a,F,..1