Randall, Sandra gores -16.35.50,000 (17-1423)
4
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Dor 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. 6Q f Registered No. 2 7 f
County - �. tt TT�vv-r1 - ��', . 7
Village
� 81-City (If city, give street address)
Name of deceased - /�-4_ �/ . .__1'46
�� �f ��� Single, married widowed, f Sex..t� Color il'At C...,or divorced (w;iitte�the word) Date o Death U` , _" 1' 193
Age Years... Months ,fir .-.1Q45,, Birthplace // i"" ( "L r �f
Cause of Death / � ,�
AIAt-I-aii,_0:......___-
Certificate was signed by t - 9
Address r � ?y.
M.D.
Place of Burial oval) n / _
.,...(If body is to be to i fi in space later) '�- - J� ( ,��/ r
Cemetery Date of Bunalif/ —/ 193(If body is to be temporarily eld, 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 the basis hereof I BY REBY GRANT A PERMIT
to -...._ cy,� ,.,/4, y,
the ),,..
Address)
(un ker to hold tempor - ....... the body.
perso having charge of ) remove, or o ise dispose of [state how])
Dated I 19 (Signed)
l
This Permit is sufficient for the Removal (and Interment or Cremation) of a bodyany part
to Lot f t h Re eatRegistrare
or other regulations), unless removal is by common carrier, in which case a Transit Permit (VSNo. 62) isrequiredt to local cemetery
L ' -3 A r r+ ". .> 3• a. �G'' ,_a. a � . .
va s 4 a vo L, a - . oZ o ,..y ° U.'ZF ° c'4 a 0 > N_ ° ° -,° o - y l.
naaoc0•� ao . ' +' aa. > . c ' � a;., ° • 44.�e,. d . 0,a t. o.' abG w 0..,, 0 0oc -1 !!EEJilI
i!IIP:
� aNa v ° "�u' �iyoua v. ° v W'o>Az . d -a . a 'CI u ° CdZf+ .y at Y^ 0 0 a ," E 0 0 o;
" ZW .Cym ` 'd � ao� -) � .0 c c) my o4 � c c'
tin ' � . ° baa a t"u ^ a a avx ; a ,,, P,04. cdadr
� o. .c ° � � � ° Uo.cot, dv °A 1 ' U
y...a u q.CauwG'C to
,G�, bAnE> m>,'3ZY y
• ,V9 P '" .O by — . YO " wa
^C � aW 14 ,AA .' .
u p a a Aa^y ai n � � .Y ° a� t, cC o�. Zo o caa� o :�tao 0 $WEB o o �� �
azwN z _� � > 3.53O1 . t;-' y, >, n'-° N O ° .4aaI -• 05YOcdd ;,4.C ,j a .
F-1� zj ;; os o v o ° a.+ ,.+ u,r.... a > a I-. �vt, y•.. bq . ,, u CD
0 cV10' I E°'C,..• ,-. a ,.QJ .4•� v ,-, * ayJ.-Sfl ,gvy cu ` •5.•° ., cd 2,- v a 5 _ u -m -'-'14
-
-
°N , �� . a . £ cO. o .G� a= m c.•"•� a W G
Zci ,, ,m ' mat " va , t�,i.�coyF n o a cV cvt�,g a..Z a ca .a•� ow p,-'° ° a a,ca °sWH d.
c 1. tru >x ) o, > ate,•° .> ,, �, -. � •, .g ,"O « coa-oaao.5 ° ab •° a� ° 0".u -° ¢O
Q X O uL °' i.,� W O w c3. a*. A3 M v, a "_ C a .-, a s, 'tcdv °_ 0U ^ U4
co.. 4 aeNz ai
E,r / -H8 m «H ca I4a« E az u ct•.c"c ° 0 ° bqa, a a qta..Q ., > ai b.y ° cy a v� > aya.. �.. C4 -0
m ° t,'4`a a O"" , ° O ,,- v at, ou0 � aNv,^ 0. .0 ..., a
.0 O .,2 E4 si o " ^.., a. cd0,c� U "_ a . « O a O tom, C ca-C a ,° , (9•i Ga AO 04 a
W! + o.
-W 42 y . '� _ oa o..co0U •a° N0-- 0 = Caoap °, o.° Q.-. ,..0
o
o > t c c . y}' a Ft a 0. : N a `' P."4. 0 a . na°.. `. .QG,,..fi,�Ok a,a 8C ww[-W.wO at°; �.� a a �^y b0°, c� OP" bn0^ ,. � a °y•5i � >,.. N .. a ° O m x^ u � O a <0 ° � rod
W "y k � t,.G,-0a 0i ° :° o .aoa0 > aoa oc . a a .da ° -q�
fa., cc z0 •zW , �'C '- 0-° td, t t, o tia aQ yc: a 7G....� ap'ato.aVOb;yEZm � .. n3, C a idd.t.'O .1:4 =
OV .•--a. «rU r1 da a-.+ v 0 0 0 Al 0-O O t.# E a •R7•71 t C4.0 ap >,c, cd ° a � 0.,N..,° U tO, m b+q O' yw a 0.< C
con R Ny .O ce ce Ut, a..., t, I-) ° U.5, Q d # a °' w° 0 .1a7 "0,6We (0 -, >yyb _ oF t" O o, a.o ,., X Eva. . --... d o.Zbopa)'O ay. �
C4 1-1 Ny -• .3ia v 0 A' wO y cd dV C .+ U r n d
>H1 '42,z °• 0 t,•i, 1-. '° c u , w ; ,. M . E.+ ON � , >o 4az «Yy°Z doQ 0 a > gaado auo �°y . ° a b °.- c " . N ° , >.,6 ~cnt....
r. a-C : en �QwWW ou° -C au• s a o.ypo"o=' � ° >. °ooay ° 90. � p « � � wapes0 v _a ° I) -0, ^ c, ao.« 5 ": a a, n on .4 a .-�ayE
2a O u y .. Vct
% "••• X & Ou > y ,0 Yi.,..�,= .., .".' a-o •.M•a. o Nbio ~ a a a t, .-0 « ° a ° °,� o $.4-,++.> .. 0 o es0
Wa' 0CA + w o � 3A . a = !
V °n W doc0 ` ° � a' -, ct u ,._,0A4 ` ., "5- 0-+ 7:1 = u.40b �L. V,
CW a ac aN�a �o a acs Z � . o ° ° I-� dv o4 N.5,`� uc • a � . ° ° o • o p. °.:'y 00 °x M .c ;w
O C O « �i{'°a.g ta'b'n O 0..,� a t. a a.. ° O; ,-, o - 0 O a,> '� an aD ca >,t ca t,^ C'° ,n ° b .. t,.
wa,ra > uMw , .>,pOa00•mO X'L cNO t,M �.° a, ca^. tm a 61) Za
Y °>4 0 0 IN a ° t �Z t, o .. c,.° o.� bq m o v , bk a,a
A47 o • `m tAil b-eA Q _, y[ - O �•• O ' .GZ c ° V, .b00 ce �.3- 0A0. a., z0 , � ua0 ;zaC
� d � m u OA C ° oy: a , ' a 'i t, a.aya . , bog 0 ° t, 0 a t. a " qb e. O., 5A= "., 0. -1
" P v� o o0oya E v011-• -
' W. o aoC vz ° a.9ov. io ,. .o� 0ca.401, a
V i ° ., 3ot. .' Pas