Litus, Nettie Form VS 61. 6-8-34-50,000 (17-7901)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ii 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 la `- Registered No.
t Town
County E.e0 LZ,h,/��-.(41 .- Village
ley (If city,give str ddress)
��jJ �;
Name of deceased • W-6-141- '�""'("'L ar.. 1
0 �/�.� Single,married,widowed, /� —
Sex. / �f. olor 1-+ -s., or divorced (write the word)U. Date of Death ,/`z:, ( 193`-
Age Gam, / Years A3 Months og Days Birthplace. . .... . .. .. ....
Cause of Death ,...J' o, . -
C-ertificate was signed by ✓ Q iT, �.... - - , M.D.
Address ...7....3
Place of Burial (or Removal) .. . . / -�...... ........ . ..........
(If body is to be tempo i fill in space later)
Cemetery . . . . 7 �,,-Lr ,.,...,. Date of Burial a :0 19.,-5,...-
(If body is to be temporarily h d,fill in space ater)
The Certificate of Death cont ping the above stated particulars, having been presented o 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 there f I HEREBY GRANT A PERMIT
to ... .:7 ...3.:..r,.. v Pz-~, 4,. - 4-
..v ,
(/, Na e)` dress)
the .z �`�'e� to hold temporarily and ....— the body.
(Under aker o€per n havi charge of rpse) j , em Ye,or otherwise dispose of[state how])
Dated .... ki.N... .7 i 19 6 (Signed) ...._....
0 Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) oa body to any part of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Trafisit Permit (VS No. 62) is required.
i yEy O i. d'o -w •n I. a),- 1, ~.z' , ., , vi i.73.
`O Z y ltl 0.0 d ° a: O ai.-.'n, -. 0 U M p O. ° =1 0.L) 2.?� O d O 0.-'4 uY.0 v O cd"X,,, `� O O _u d O=''s7 OW'!!
W Fa I.I. 4n..-. p,a> O O Y w.y cl a y,.b a+ -a N 4 f" - ''+ y a+ O n •y. a, o.., 0�" v
w '.. C) O 01. , w•~ aod dy.1. I30 ,-. -O 1. wf~ d - d.0,�, 03 QQa
.°, qbd° aovdca� oc oa)A. , c-c.~+-' -oty >,° o a 0� 1Eoo o.~ 0� � °� 3 ,, 'aa� �v°.
O 1. , y°',u, o1,• uuas.4d a)_� a) �.�•�04 aid 0.) a y d 1 d+ > «
W W 3.� oid ,,,x boa.., O y ,=0 n Oy 0• p,0,o. NEnU y o N ° C U U aN b.• ai ate+ty sa C4 ar
'-. o o d d N �, .. v.• a H x > 00 d
•�, _ w 1.y.~ . a O N O 1i w °. i. 1,... O O `�•� ^ ur w �. .� C a) 0 a)
3Q,23 p� p00.,.., 0 �,. g� as > 00 °� aw00p,� N° ..�. °�c�3•�.C•d -V:b,N ob °�.�d+ " y ~ '+�''zi�
«F 1 .a, s. s. ..+... p 3.•~ u) 'b v .0 Q O °.+-• o a! c� .0 oN�'"..Vi
a >. -� bp-0 O i...-:p Val y cs a) 1, s..-, .�.� as A �„'t7 'O r. .c•1 i. i•• «
O uCC « �o � v• i'y'O °�',�� w• dv v~Ni Ot�d Oy a�•3.'"' y y'Cay ° ,'� 3Jp,.��+.b O �� a itl 01.. a,0 dQay
qA vd a a.4 0'b >,� ae d• 0-- 4. •~ c ao N" u °0�� �. d s. �, o c b �'~ o a d
VI Q7. 0Q � u Na�� � � b >A � 0.) ....... y ��,' a�a) ~ 3'bo° Ov� ° ° ~`0 Na�vcNdO� >'""C �.4^ "
W ti•. G.~ > b 1 db�+ i; x s. d v o.. a� d d d o _y N �wbb ca.
z E.I . U r'Oa'°i u.� 000wC.0 �. ° m,° aJ d ,. d... 0 d ° apu d °•,; mOdm
"Z d .Mi Lam•�•0 0. 0 0„O w.f.?
.ow-0 cd u� U4O. �N O,.C.• O OA �.y O.O R7 N O 'w P.�wO.;'O� p+-+ �Q[ti 0
zFWfi1 . Jo «wGq H q 3.Za.. ,, 8 V o88.•4'1! 0.o40, a..0 ,,, 8bo`o' 07 W:'yp° a aia', a) a0c�-8 , o � & � a -ate ..
O a, I. !v O W d o U T ct ul `b a. of 4e,"+-' ai O > 5. F d a7 .> a) 1. b,., c a) U d N a,-ate-,w a V d N W °
o; E-I:8 d ~� n c o,y d uN a.~ c.~. 0 p N N > as. a= d.� 'I', .. wv)
\... L 00 17'1 O•a'i. %'o• 'a+ a! cd+-' O M 3 d d 1. O y, « .O 0 >p a) L O ..0
�1 `; P« i.' d�.•1 Q O w++ u, U a) 1. m`tf 'cis a! U 1.0\ d 1,.Ly 1.p ,•.,• ,� O >>" u ,7s-o 3 -o o.>,C u•-..-. «,j 7-, «
El WIG p J ,w V r .D N ° 1.,ti a,v.a o.) a o din,'n,4 Q.d.•-, '0., .d. N ... �..0 a+ .o C1 O U y U ..,y..,-O p 1. bpFy > m 0q z W 1'
o '. to uu w F z» O O g ...• O .+ q 0 0 cd U at•y 2•y O... 0 ", 0
W E-I a)... at .• a) i..0 G O
Q.I W ° d -0 A p a ,. �.0 ca y' ai o a a) O 7d...y .y u,•., 1d, or ,�, d r-^0 1, .0 U.a r oQr, p.
�J, ��•••• -o.. cu O O�• � O a mod! 0',Po w i.
ig h••l id is 04 q d,^„ d q °i U p i. '•�.��' 0 N. 1. s..w 1, N co . 1.,2 c. .3 Y a< 14. P.6y�) ° ♦,-. N '^' G+.+ W d
u ~i V 2.. E. •Q.--. ad+'u F y0.. y > 0 y 1. O p U w... N ° ✓+ .•'y o i, 1. a) cd O a) °F O
O V �..O1r �wUiO Nadi.0 ur3udx w'Cd o1. 1,v°.«'c7 „...y yis� bq.:.n � o O.A wuy., d «
'T'V�7}. "o o2N H ° c�b� 3,�Ny'�yN ° zx a'� ud.cxc•..._ � 0 p. ,•Eb� 6, 5 a�74-1,L, .~ 3 ai ° d acocx)
,Z►-4-I 4-. a - v., ° v- >.M U 1u. 1. 1. d-c 'y.;.d.q d.'2.4 '' 0 a° m t ..z „•vd.1a o ^:. " ,, 6-. ,i " 1d.,°- •`= ''' d m " W V7i.„
d > >4 U O d .., d ai .a U 1. a) > a, ai d:+ U a N t. ,. 0 N,+.• 1..., -a
apadtiF 0.4 > U v,>7 _ -, v tq ,, d,aa>,0 d 0o o it,. m0i.' .. ..l Tr 0
Q 0 a I,.i W 3 t ai y '> ~ 3•bAin b U vi ,.-,.. '0 ..r O O v.,., ai',„ d O - 0 O.0 00 v 0.� r o
so v.°1 d o U .c 7p,0 s y Q 1» C cdaS ° Um o d0 QCOoOu a QOW tL
W �`� U,J� 0 4:2 « Z I, 1. E• v, .id O d U•b0 a).d 0',1 ai d,o =-0 > ay 0 cq..• 0 1.. 'C7 m U•'.'i• aS u " ,r.,
�j1d� -.. °. o 05a u [� ° °.~' L-71-:o > caa gp sd. a•� 1. a� 400 o � q0b• � , g249a,a > � `�n -� '� �•- 4''zF 0
(/l^'� a� 044 W4 0 o y 1,'•U• �~ o.0 ^ • ?',ty.�'C� o; o d'J in d .0 Xd.,o o in m°y v LO •° c�6 in �.dii'b �iC C..0 t~N~mo w`."' 'C7
6 W o -� �' ovva) Oq� �Zi oGa atQy▪ 'i� GF-i s, d^- �,. ?C v, a�••- a, y odou.� p a) 3 ofY. �
W .d ~.d. v, C I-p.-o a) O.0 - o y, p C,'.0... «....--. W a O w L. C�", G M
v�yzW o F „ ° °oa 1. dN 01 d•~ * ....0 - 0i' >s ". cp7soom-c^ V.' odcd z "1-II
O�•W U - «-0�.1 v t.G,~N„ cd 3 1d.m ° o o at 0-b p 1,-,*. E. V.°~• g -at a 'ct..O.-QQT.0.n O b.007+w U EI,E,:,��,,,�'•°.0 a, "' - v Q °0„v� idi
rr�'.1-i f w d F i.�, >+~''+, •51_, a O g 1.w 1.9 OF O. td 5 ii a) U 1.++4. O'J0 a1w N cQ U d a 3 p �° i. u! sr,__.O ai 1. R7 d.<
GI 2 e, a F a U o z c3'bA a E'.. at d Z' I.
b ° U w h p ate-.y ca,3 ° a) aS y.~ aid i7 v,.0 y�•2, U ° d 1 in m aQ,' tr
2
K• 1....-d a�•-•'�' vi 3 u a 3 d 0.� 4.0 .0 0.. U... O ai... as,-1
d ° U Q U U ai O U U"o,ai 1. OJ'".. o O >, cn U O.. F': 8 .0 ,. .C'y 1' .° bA T7 i.
W Wy 0p.0 4 m... 1. d .O..-.w d # u ai�•y y ai -0--cd p w Y d �, d ti(!) u, u0.�'%•,•• u, s. d CA 0 0 d
2 C4 es dt h-.emu LYi 1-,-, v °y .a p a. v, °'> al ° m +a O ° .y". m O C a L T�' I. p >w aS-a„ '� « t.
I co
W a .a •
f d y. .. c V d+ p°'-,"''U V a)N.-.-0 0-O•n N'O N 0•.'d0 " CI A did 6..cu a• 6. a1 d y Yd. v, y 7` 1. a;40 p 0 ai °V 0 d Q
� oW �3 wQ100 ,-'., aOm ° uUi+ VaOyOvd, ao 0-0, ,cctiv) =-� .°'q.� 0.'el , NQy�N ° � +''5�" a' °oF�etl ice+
0 w> p+� m m 0 0 1. al 3 .°r-1 o b a X.5, m
Jy o as cd•�m...
ti
„,, a)'O'�• O 0 m y I. ••a) a) 0 �''°w u y d U O `''", •�, y b/)-� 0 g'.. Ow d .4 C'O r, 1. W
A gyOa « ' cd'7... 1. v, CZ, dd 1, U.. U•r p v yw �ZO • O T. U - > 0Um ^ o � a) 0 a-. (!1 id."wy.
'�' p' d O 31O .o• '+ O'+.• k cd' C > i.lit
aAzwA � oi• co°�aa°W,-c.° ° uc'" > y -. ,.▪ am 3:° N� a -5 04-,4t5 >;c`o° u�'� v'"' u-'oa,� _ o+d- P.nQto
1b Cn QI a N H d w '� ig 4..y 1.:'"' p.1 a-,Y�. v.C: (1).01..0
1)).0 O.0 Cd I.
0 CO O d.0.0 0 a x w bA 0 O 0 1. O N 1. y FF,d,yy G V y 1. 0.>'i..0 oVi o
A �(/) O.O 3•.+w'N O >w 3 3 0 3 a..• P.V) as p. a a., v1'C".~ ° o•h 1.,aw O 1d.0 O 1.W 0b 1, Op ba: ,.• 0. 44