Bordeau, Emma Form VS. 61. 8-16.35.50,000 (17.1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Mr 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.... `49/ Registered No .,'y
County c
Town — -
... ... Village -.�.5 ��1a , i,7' �fof .- .
or City (If city, give street address)
Name of deceased - _
�� i_ ,C Single, married, widowed,
Sex... 71 4 Color ' ✓l t or divorced (write the word)Zet Date of Death.. . ` 2-7/j 193
Age k..y Y rs „� Months„<�f. ' Days
Birthplace
Cause of Death.. 4E--
Certificate was signed by... + M.D.
�
Address -�' C.r1 vu �j
Place of Burial (or Removal).... `� ,t�� ' �/�"7--1 '/ 7
(If body is to be to ora ' eld fill in space la�f<) n' � 3 3
Cemetery....•.. - Date of Burial. t 19 (P.
(If body is to be temporaril 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 basis thereofHEIj)F�BY GRANT APERMIT �;�, A
to ,G� -P �c- 5-20-x-r - --rala-../ j'
ame) g press)
the to hold temporarily and . the body.
(Underta�. or person havi charge of core e) , r ve, or otherw's dispose of [state how])
Dated .ii! • -` ✓ 1.9 3 P (Signed)
Local Registrar
This Pit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local cemetery
or other re.ulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
Z E. p m O v,0 ^w . 'b s, v^ s. q Y w , v V)4 4-1 U) ;v i'
L'U3
p 3
Xn
'xi i
i.Nn - LYoa) oO0 Y ..lira O O
>OV6 so ° .. 01-. '""'- p,= ocsv '.y ,. >,o o• � oo E � � ,, : '-"u ,4 G a, ' � , , . v . � v ° n
-, cn 'C a O v sue v v O v . O v LT, a) O " a) .,'y � b0.a i, ad v L 0
co d
p a 0 °) -0 y,0' xr >,a o y a o' a,a a,.n y'N .F o av a a.) v 0 > d O0,,4 .CW� 3.� aca u 0 ••bp w a � Ev, s+ ;- y -o 3.� a, u� d� vovo -fl J • �'t •m :tea . °a-0 o m o oa� ° cd � u ,. ... w ib ° Op coa. �. C.`4yoos. oca vU ,' v „ z ca " sa c«Q[ d 3 `-°' �`8w av v. . v ,`.'
• " ? O O C vyG v .yO '�
O
ifl1
T v M - vi.� �• aa 4onaaa 0 o a, ° -oy7 '�
Ac/� aa,v y -O ra0v'.y0 ) � 0w -0• �v '-' .610 m yuI ; i
V) AZ bA y ". 0 E.vada20 . ' � AV) a v 51O} uov � S ° a^ « a y bnO , v} a) b v U R� iO0 W W , w wH .a•3.4 — , a u s , y yo U Oc > „ a v s n vaa a u m aaoc aa� d'.. a '>A va wWF"ca u. > 7 y.vn, 'Ouyy Ov vN '; o > x . �,. ,.0 a,s. a,. ca ca a) ="wO gW07
. v ' . oA c4< Q's a• N,_� � 4.yi � i.,� a a') 2,2 co .O "''n: o,o >,+-' t v<a0 -to �a 074— .. z t
W2 = �fdx O-- Mvvvvv �'G 0Z1 aav- .os.�y . , oc' r,b 0-F. ",a- O ''w'vO0• .'5. >.' ao W S.
• C a 'pv ° u , .. • ys.�. a v'^ ad „ °zx ° cauu, o4LL7]fi d � • o ca y,, v O- a • s. y '. ca a v' v'. Z • . a , . >.n v v"' G 0 T, av ° 0 w sti O
xrrv4 d aaz d� oco x3'° -1 v0 3v :y 0 � v � w� p $5 .. s bc aby�+ u °. .,•- .. �vvv. 6Oa m4c' -'4- �+ .c. 'O v .0 v., aa O ° a � .�� v v... E"
Li« � ,"W ,F' 0.. v,+ ca v'4 .0 c+a v � ^7 > v p•. 0 — b a . � ,. � - �....n 6 u• a sa. iAs"0X . ... mE+ I cn cavvv3., �.:Yv"og '.o '� , IIv0-- •, y3m'+ '0,.v 4A. a .— v isv 0cm74 L
V(/) c e °N vd ' �vya v a k a
0
3 pu � .0- v O.Q >,'..C •5 v ' v �,u� ..
aCZp,q y Va u . t. ' v "; .� ai csa,.N. ° v U ca,.^„� Zs+ v O u " `'bs o . �•E.� W
0� ° u °t, u � 'E a ' I - p3 .- oN a � L' v = c' ao zO ,:, 0zAbto.,,,o 3� FWa
,
- F. a ,. > ., ct . a a .. tyu FO
q ;p . �� , a � � °� z6 — ' aaamu — ,L, ,9a ,. 'c , v'^.; ou �a-, a � z tXE V:a °'; 2 ro;[-a V ,8 2-r, r_.,4 g 8,2 to 04-P :.E Y o a� ...n o.y v a vv L ,a- v...y.G a4 a
Got4� �, ,, �ia;yO s" Q s •> . v, v v4, v- . O_ 0 ,- 0 tj A,4 aJ v.o0 3wyp4tL z r d Cw W.. w o v 0... Id ',n, C6-. oia o v �."0= ° y ", . E u bn "•7, . a. . u . 0- v o a
f:D
Ovv oE 'a O.. n v a._ a. N'7'� 6zOZ iyOa - .7- bn 04 pP 03v t voY•'E 0. � oo : 7 5 aa ' " 'O*civa z1aW > �'C `' o3o'*° ,1 5 ,• .- 0 ' . v � ,.." i,_b* m.4. �4voo6, 0 yumC., , :50 CLU.0 nv
WV �. .,w*- sr (-+ 0 . 'ays. o > a uo s * as ar� v* °".y , 010-01u ° bAd vv..L4'. .n u _q 0 .14
° , u.., b^ ... ° ca . v.4u �, gO . M1-• iag o
ham' m oOw~ d Vas.. >.+,�yy'~�..m° au a,. OC 'v,.. ,°?� opu�.a GteuaF •
0 ft ,�4,owOn >4'a ,v� o'aouv3 au,d° 8o v i, z'gbv'L7m �Q 'et.Qa
vHR u o,Ea.bvv'i v..6-a "?,—••� wn �' N U • '- 3v O : E'.'. � 5.0 E r v.o : • � bA,p
W W pOQ 'a4 Z uC v aa+wV °"d.� a m O aS°'C,-1'4 ')4 a° vw ,Ib ca-I" d .'� o�, vv.5.R� u,>awO re �w
2 .p,4pE�.. u v, O, .n p8vn ° ' yao y O °^y. ^ a 0... T8v
co " Xaa > .'y " m 0z . °M•°: Py�,0vm '1ra.,ZE. vAd .. h >y '' V,a0z .5 Q
W Qd .0 o� dOWs, v,v 0O in w,a u v �,. .t . ybs n+ O v bn0 v v O s. 3C 0 . ca y cy ca j � w ycd
c/ upwO u•- a aO uys. .4, asp, yo ° 7u b >v �.� a'qA•oac ' no = u., ',cao ca ct ca.aox40, 1tlo � uxv . a o va , e . -0 Cw'>:A C a yu N0xT � a 3 S , 00, _ ,
• 7, s '", 8 � � Q ct d .°
C/1V. ..a 0...2 v ,. u, -' . a) O w t:, .� O >, v^iv5v'bf; OCLa vvsU• v.40m01.+-w >,G°O a c> -°•� v,,-,'., >,O Ta .- N. N ° O YO., ,u' O4
Q d O›.,aca � \ vy'i O ,..,•o z ,_ O a,, ac > 3 w„w a '>"p 0 vaO 'n ai ca v OO cao ,^... O b ,n4' i Q• .
wO dCQ v 'n bwu vmmCa ' oa0 ° L.-�. o y." a. ndAa � °v O ~- nMaai° aza
° > „ C"° . ' QO
W z w aG o ovt ° 1a - 'O Owv .-^..� O y°. m vnC3'� `On c .,''x� mvc, s.v a..s= wo6- -E1 Ui• bv"Ga °s aai.,^s '�C ° sv ' pQ roV2 04 a u n. O A 00 O - v.Cn5 a) n . E v �in uw ° ... aa- � a�io °,.ga~io ... ao .... . a 'zs,,� ^C0 4a v . axavy . a• .= Q ,a
A - —nao .,w.,wno >4. 33o , 3a., a. "., u.., a.a. cn'o.., 00c ,..n4 Oca.001, av '. o.aon
t