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Harvey, F Joseph Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT IM-'This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra- tion,District (Town,Village, or City) in which the death occurred after the FILING and acceptance of a COR- RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No....5-6.,- / RegisterM No. County IF Date of Death ___-19i Tewm,-Vil- fir ptL dor G 7 --�Z Se Age _-Yrs. Color .._ age er City & ___ ' (Or M (Cross out named not applicable) • Cause of Death - -Cs �J' _ Place of Burial h Ceme ' i 1(lL 191tr (or Removal) �er Date of unal___. A CERTIFICATE OF DEATH of7e-J __ �1/f/ (Give full name of d ased) having been presented to me containing e abov stated particulars,an fter careful examination, the same appearing to be COMPLETE, CORRECT, AND SATISFACT RY AS REQUIRED BY LAW,I have accepted the same for registration, have recorded it in my Local Record with the above Regjster Nu an on the basis/ roof I H BY NT A PERMIT to - (Nam2f Un ert er) (Address) the-__-..�.ehw_tc to S the body. (Undertak r pe on having arge of corpse) (Inter,r-m .F�llss�S�'�-dispose.' state how]) Dated .-- —�__•__.!_ / '(.(�-��� � ---1g1� (Signed)-� -�--- •--�- - Local Registrar This Permit is sufficient for the Removal (and Interment or Cre •ation)of a body to any part of the State (subject to local cemetery or other regulations), provided, that where removal is by common carrier, the above Permit must be included in the Transit Permit. 6.27-15-26.0O0(21-6R611 . trs co Pb d n td W 4 nl w a F. '7d R : \ S% oPbo5w ro m o Str.-° m i t qos % \ 0 6�$ 9 m°'4. C w o v;170, °'r• "o$'S Q� o S9 ° m .s1 fi�o m .. 0 K, + isp v m R {3 G• %t3 m i m y i o'::0� RCwRpA o����s o o�&o rop`"y��°�• � d� °i4 rG dm "� " ° bj�� Z VA 0 �71,V St rosy Q.. N tic tc.n .0 t y N to ,4 i Su S•0'.01 'p e"0 O p m +' ` .1 ¢. ro p • 0,. fr I ro r*n Y► .�'.. ro r.Ay ?•a* % .,5 O t • VS ap CC • �%wyro � m-. S� ���Koom � t�°R`�O�ta�°G n Gc "� rn, S'°� m Al N w�' �,,. 11 Kmro d,H,n O..rmvi ,-;; i% r t o t4 , fD a 1 }��„ .*^��� �H�+,"��•P�T% �t' e� C�p�m `4 w`"'a ' 4 i�'�R;�d:°A q � N. Ei O is� � l�+ W?,yfirj '4: O P• ro ,111 P•o, a Vit p S"�6p p rm H y , r+ ..0` . . is yro.e pp o N ac� p. �.a GqR+, and N a m .4 p t R: c Yid w+` Itt@%C3• oT' Pee SAt'sR °tR``A;01$ O. R.• fig. fi o'; � ti) `4 �• ✓ ' ..p 'rc .oa. Rp m inro '"rRi ,e. ow 0% m- K, m; �.1 0 A-MI V it drei .� d" , .,"�oG or•P„ R�t���roo �3 amp3 1, RG„0coibi'ypp. "q4��' Oi3•G•4 ts.m NA 4.* R'N io .5 5.'A�yG 3�,$tn5I C ro G. riOolla O miNRm�Y NH'[S Op�Rm and Nr•»$+ °•Tl.r '„Fs .s w .3 m t'.�!� v ` c"..P.cao 0,,.1m 0.469:3 ro $.pS S'G•x y ., d1.. fi it 7+ 0'4,•1 S i° a+ •�t%"it)CYOO ro 'ro ro%2,d RK wm 11 G .D p m ..,r t=iY•3 0 (11 ,� 4 m�,wGyro'K' C'**1mP• ©. t3 mmG•re+•.., omd°brr3m�"oW m„"''' mom *." •. .+tAr''g room mid m roman.�RG'is tt-c-. mmd G'ro 9 e4 papm 't. t4 � �sStTt�, G o����„�q,.m �.R d r:G P•�M p,o�y^ tf w R N N 6�e`� .'�-? •fl• Rri• t • .-,oe,17,w .1,?11,,"4 e..„,t'clo&rm (4. o G^r. K n °,. m s ,'.No / Vi +3 "� "�tQic�o w�i- bs CmfirommR r�yP 5 Pw� R r r C sit p. " 74 Y,W e� a m a ro j. 0 t m d R .... 5. VI m ° ^+.M m�prnq tsoo "iroi pomGr�,i°tmo .d�9 j �";"��*, D m NR O � dpwpg� rR1• row ��m , ps''' 'g-,w%n^vn ° If104. '\ V. ^�ry'1,9 ~ °.s'� dG• Croy '° C�G�°e �i 6cSo ro �d m o • CO i 't " 'a 7. � R.dOP•m40Rm G °.." ro ro w p+, 4.,1 ref q R m $ poeil-60 omo ?W'; ,„- z �..,. Aaia,d�t,�;gyp'aa.5 H �.ro . 1.y O. m pg.o Gmp xRm RGt..Lt