Boss, Joseph imaner
Form VS No.61 NEW YORK,
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Qom'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. 1 Z_._„„_. Registered No
County i%lrtn afar.�• eitDate of Death-_-y '� 191�
Town,Vil- /
lage,or City-"- Age e'CoU Yrs. Color.._idt ,
(Cross out names not applicable , � ,c, %� ri.i Most
Cause of Deat :
Place of Burial Ceme- r ,i
or Removal �-h- -•Date of Burial. _/rt_..191_�
A CERTIFICATE OF DE of _ -
(Give full name of deceased)
having been presented to me containing the above stated particulars,and,after careful examination,
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 thereof I HEREBY GRANT A PERMIT
ab�
(Namepf U tertaker) A ess)
- to _ _ " the body.
(Und er or rson hay�ing.charge�of corpse) (Int1er,r ,plloth to how])
Dated !a- igt (Signed).° .. .�. :a`�- ..._..„._._._ ._.
„„ Local Registi'dr
This Fermi s sufficient for the Removal (and Interment or Cremation)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.
12.80-18 26,000(21.18017)
-L-.„
its 1., 196
: (p
, ,,,,,..1„. lvi,,a, X L A tL4
L \ to, 0 ...,
'A 0 t04 •00 ,-,0 • \ ••
0...E0,,,,,0 04 0 II''0 4. ,,,,,t.V•,,p1 V.. _744,6, , , .
115 e `': ri V d St- \ , \ A tei
• ..,,, 0.--- ,.....
• . , fp 0 IA
PW' '"0Vi;Sl. 0 rt 0,tt \ X t, ....:.4 el
...... 1 , 1 r.d
c•0 V,ed'OCt tPl'Ar ; ; ...A
t 1 ''.,
•0 vs'f' co t. 0. `I o .
tily.,0 05'014•T...!;, •O';,..°,.• ' s0 0.0„d0„,w '0'0".?..0_.?s.1, %1D .y,le, ,74 %
5 'la 0 0 ''.."To V t n• '09,r s;•9'SA 0 '%?..--,.7' I 0 0 11 tP $ ' % cl."'• ,It,):ei
A St . 05,.,00 ,:t%0':::149:‘1 r V'..0•.,10. ;1. 07.6W C.i.' 0 t.4% '6A: ' i VA til
tr,'-'41.10t 0 S 9.0,,v0--`10:0-r,0,-• 0%% ,,,0 t,A" ?.,z,z,0 T..' ‘..'5 14.,%"",0 0 Le, 1 ck. 0 9.\ \ ,X tko_LA-tei
Vg 19' 0 TOtt,AVV04.-Lo;?•,''eoL'4'A. 0..0 5,,t'LL"'.0 %k4,•.t e.0•.S:' t .4,. 5.1.',tA 0, ' \ _,_ .., _%.\:' -Fl t4 vo3
L,,0,--'0 cIA er'g 0'0'0,-.'„,„r, 0.c„,T.,....,VA 0 ,-Fi-g°"a."‘0 1,,,,- u: 0 at.•F.1°% c v 0: r.,tft vi
ce•A14,4 Tilt-..0,-P• ,goc,-,, ,,,..6s 0„,. . c- ;;:o...,,s-1-.%•s. --,...4 . , % -%
--vP1A t.to,-..0 ,,,w-,-,,,ii3O.0• scs•pl 40 es „.•,. ,:,1„0 To„....„, 0 -. t4 , \ ., n., ;-.:, 0 c, :, .
1:1,s,,A.0 -,. ...it 0, 0... ..c,to ..:.0 .,..i.,;.;:.4 :,.•VA. ti.0,,,,r',..0;:‘ -P4 'P 06 ....,,,\ \ ‘s... 0 I.,:At
V v\ vA
‘.... •%fie°, Stia.0,Wp.%0,,,( °4.1e-"V SP'C'''" VV: 0'.%':-"I'g%S"/ ra" t t'i° % '. ' •'', 1/1 ..A 0
-.00 A $10-s.'A<,),,0 30•X,s,e,I>,Or ",,S- T0 s'. ;,,0.?›.%• 0.77, ,,, IL.tn,,.A 0'',....tt.,..V.. 1, X 0 +13
'
\ A to
td VI
r,,•4'.,..,VA ' ''''',°,,g1,';'-'•s-r, ,43.511 0 s ,e6;:,-,=...,,,t-, 0 01 0..:5-*v.0 zi., 1 A 0 v;;.,t-A ., 1 :;:44 0
, 0 0.0- r,scAs.,,,•0,I,2.,:,'?0,'t.,-.0 0:...0 ,f,.0 0‘4%4,0 .4,?...0 7,1,1, - 0 v.'41A .1.1,, 1. \ t4 tes,IA
V,0 0 ,el,
y...s"",,,,i; -X %
,,,Ar'$-• ,0?0, 0 - 0/01.L.P,--"..47--c' 9'0,V' 00 0 Vii° 05.<7..;? ' ' ,4°....10 3. \ \
f7=t4V.:1 %.t.'(4Y-'9%°0--W.0%c.-4‘;00`-A t(0,ct7.',?,,, - N'I's9-°0•5 -?:, ct4 11`;' 6 V-- X ‘‘ \
tlo'''',--° `, 9,'f'0•0\0-5?ca',1,10,0 '4",''' 0-"e'T c`1., ed m";"c? t4 (9,t'A t. i \
93Avi Si 1%.":,er',0 2•0S'o,g ,DA ,11, 51 ‘z.':,%.911,' S .ii1,01,.,9% 00 0 0 t,,z4 _ ,, \
roA `,;. .‘• •0`.°0,`i,l'Po•-"5;t,.9-Y .. (“?'"--ctg, `j>"4' q i...'.4%70•0 • ,- t.
V14a • '''.,,,,t1t%c;--3.5"°Vlo v, c!,OR'' \
4* el... , 0Q v ,cs •O'll'il'i ' . t; %* c° ,
- 40 . . • 4, '..1‘ (V ,„...... .
os.
0,Acs,