La Salle, Fred Fcrm VS 61. 6-8-34-50,000 (17-7901)
NEW PORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ger 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. 3 6. 4/ �� �RReeggistered No. '1
Town
County "97 Village
-9- e'le �"� G,_ or City (if city,give street address)
Name of deceased
;� LSingle,-married,widowed, —
Sex i Color or divorced (write the word)........ 2�� Date of De th ��f2^��it 19 3
Age .4 Years Mon s Days _ Birthplace
Cause of Death o .,...:..:.ij
Certificate was signed by .,,'L? .. .... . ..... , M.D.
Address ��"', ,,r
Place of Burial (or Removal) ,..
(If body is to be temporarily held,fill in space later)
Cemetery .(/...I r 'L-t""."`+ Date of Burial..a / �'""- 19 33
(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 t bis-Gof EREBY GRANT A PERMIT
to.... ./ ���
Name) (Address)
the to hold temporarily and. ... the body.
(U d4or person having charge of corpse) e ,d_eo_:..7e,or he. vise dispose of[state how])
Dated .rYY" 19 ,7 (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.
`Z F+
H 7OR. p ~ ,,, " . i3 '00 v •-'�w Q rn O F• v, m 4 4 y w m,S 4 '• m_w•.0 4, s .... n,C
W, dO< d , O •%dp p
pa n puvo. � ., b
A -y.C, 0
- u o o..,"� c y..+.� 3 o^cd d,Gy O O w
o> E
'
'L
I. Y
UfN >z 'q" n N ^ . +i ,n C > 'L. 00 4 ' a �rN 3 ° 01QG ,. 0 0.'a piacu3� y3 A° ,.
�b >.°,� va .„ ° P � vvQ. >, wwH W2 moo PEbELa Owp y rn.RS.g.0 'Ca tiww�� s-, vb 0,, `+ v •dv i v . ,,w ..... 0v I.
° . 0O � pawaaa . 0 ua°a'+^ yb
�w . t�•^ uOO .�p w° ddc ? 4)▪ 3 . .0,c. °b. °.ic 2�x'NiO .,a v 12 o
•
axpNy ' a "ClN � v0OzC ,.0 -bna0.,,4.',W W3 «
a,Y3 F • ty.~ . ay Om ce O sw t O4 b0N' v uv O' .-•
. .1 .., a �� °a ° ab; `t '~viY « 3
or
Y .3HC O 04 ° v � � mmv0� a
Y «� y ° O ° u
,.� v�vb�, t,,, � . .. L, C '~ � a, ay . • ' 0bO xv w
• � , 4) v++ o ° a49 a .u «�, 4: 0' � ay� � , ) bomO °r L vba C 'd Oa�.~ w Q3M)0 CW u . ( cd v, H v ° m vI.. ° abyo >� `1 r °•c,0 >,0cdu.., 0— • ;, '~ d 6<I•> w0ti; 0 - ° 4n v 1 U �A
Az padA ° ) v▪ � a ' ° .,2yyo a) 69 C p, i 0 y� u ° Q p..O omN � 0 y!1Jt1JI
aov «yt.ao v `uN ° �'r, “14
4) • . ° v ° b4u. '• oZ W ‘. ..w.2D2 •b .0 a. x, 0cC cd � U9, O ` '1., 5 b > y uc) . m} 0 ,-. 0h"8 - - - vdyi -› •O, O ti W H 4aa � � ) C + ., 7A ° > 'N d: .c' v - 4c) va bDa w rt.' ►-,41.� � 'b . om u .0 ^ � r � Q tc,CrI P.
coc4 -ua to � °.':74 w•,-cd.. .Y �m '"'t1 �„ v M 3 �.i. °° v, � v.o � ) a) C fd•d.3ydo"'" 0 i . Z_a« 0 A. w., y v v " 4'd cd ,y O 'G� 4) w bya .� O E Q 4y ui •mAvF [ma( • ux Ou `n . yv axle,
k.
co
luul
W � .w .dtO O c , C . cd v� o o , Ygaoy � 0az \. a � a5 'a ��� ~ y, a'd�yvoao 3Y �w o.51.-. av ° Ea vOH0a Cz U cs oi ' y 4d. °p ° 'iw cyuca.,. anO ° = � � am N . Oadr ' 2'w. w y U i3 4,•�yC yp 6 a,'C u 3y S..-. _ OOc >im0 M O v � ..v•sC.-1,p0Sf O 4) 4 •... gp—w C 4)- E 4 --.w." O V• M o 'i., '.w .,. 3. a+bu caav u p....d � � � � uu . uu u : aujV) �` w1O � w,, � u 5 ''= dm . um.0.. Oy. c" nZ v •G u . .n ,..0 .. b0'.nic �WR ^�► Z " - y ., m j� a t ,, .. u 4, u•d.t E.") y 3 a •-.., +v rj-d c3 VO w.0 Uap v) oi + = U •4. v 1 7 aly,'d 0 u, cd �ywg0x0 C♦ G„b U ° 4) >.0 a.) �.d '3y ' •i c0 # 4)'of a ,wd °0d °w , . dybnda3 ° F_ 0) a Hi W3 + as.;, • 0bn� pdz, .; 4 -1 ~'d ,: ° ° uuvo , 0 v ° •
•a•° ° opu .cQ kipF' V. g �'u 71 °.. -d p.° � v...
cf.) i " '~" '"- � g � Vaa.b �' w ° g � �
U a > a*12 .2 '' No - 00N� Mo O -14 ^U [iz w v ° � 0y �[d-+ q 3oE o'O'v+ 7.•-'•b JP . > + aNvw O s O. s, s� > EO.a)' [ � • N v .. � WwH'OWZVI J 5 , , ` •--'- U� O � OY md -0..g 0 O m40 -I . b9 • � 5c , v•d cq .y ° '''vGwL^ O . '• 5 9a '. Gaya A
bi,
•
E-i
OV)V '-F " D d vZw� � Owra , --wvu,. y . , .. > O ! T°I
« ct v. co . .-00°.. -- > --- w O-rt. s. •o r„.4.., a i cC � ,v, L. od � ,O aiaC' G,Ow ° °= u* v0' ° ) • b m.0a ° ) 0'i � A aQ H H i 4aH'O a q � y V `s •ci 3 a. ma) dn ' ° ;: �z2 d.bnC . E.auv�0▪ p map .' v,6.° ▪ E ,.[ ac -~ u.c.cp V. E, bna4oco..4 .4dOdg dw. .~ v 9 v 60 c, ^d. °a cn � uO '-• gE O hp.°• .y0 0 OO 4W W iti . 4 4 � c) v Oya�� 3 O"> � ' � H0za+ a2x n• + 4A0 � , '+w� vy'~� ,Oan▪ vCNOo �atiO1w°; w a��o0� � a a �au ,s .b 1.4 aia :�' cJy °� 06wWa • ,� a,�,� yo.o,-, ° a•5 c a-° p .6do . ,. k_"E.f teaWy7 p °uYOg ° . uya4O ? uvy N , yA•° v,. .9dtmai °..g. d C+. .m, > cC) gQF• 1E0 ",> CmQW , . a. mo u '' 3v tivd,•C v.. a0nG• i ca o v ° ,. n O > Owvu °� Qc u. m id u• UQCDayO M v w U• 47 py yw v Oo 070 ",,_ °• o ., ° � � a u My• . � ac'"vCd v ° >• N ' • s • c °. oA • d °• , ° ..Zo [,, •dgaro� '5, aovME cd000ct-0 ' —•:V:, o 'y'ywaF c ty0Q�• ce .�dO ,y4hi Oun OM u C "CI• :�p NM Eo cd� bn m. � E a � aa � N � o� gy,d O aAF• o . 400 �°3: °aZ �, ' 4' ' � �y � iaW ga6 O `4o ai" baa >7Ny
1.1 k.
cd
° °" . C s. .0 � n -� 4vu > ° u � oa,
cs) Vc:0 . oG �v_. 4uZ yd x o. a y I-, .V) ck �o-t aw y ,..> p. .. 34). v 0 •.0 0 O 4 . V 0 ••,-• w'. V 0 ,. ,:j ,. 0 a ba- aH aA O O • -�, O w� ° ,. a., amaa u. ...., .-d._ 0 Om ,.aw 0 caC 0 6,,,.1 ..,
al