Gagnon, Shirley a..aau ♦.�. va.. v av» i , v ,ai a�c�,
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. .S 6 0/ Registered No A ay
Town — . /,,�
County �- Village S "' /:ftl.y.�_ a' }�
�Clty (If city, give street address)
Name of deceased .. a
Sin , married, widowed, ��
Sexei � Color 1��� -or divorced (write the word) Date o Death � y.19 34
Age Year OiiMonths R .,
Days Birthplacef/ t
Cause of Death
Certificate was signed bJ � � M.D.
Address
Place of Burial ( r Removal) -G �' '-2--/'1''.1. WI-
(If(If body is to be to raril d, fil in space later) /
Cemetery Date-of Burial frmee,-- 1 C/ 19..3C'
(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 the asis thereof =EBY CxRANT A PERMIT �� ^ I-
to W' '(fYJ
(Nam (Address)
the to hold temporarily a L. the body.
(Un taker or person Vying charge of corp") r�i/f ove, or of dispose of [state how])
Dated 11'i 193 (Signed).....
Local Registrar
Thi 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.
O ,. 0 v-c ^w l.-:'•c) g s. v-- ,. 0.- w bq+� v w p m 0 ,. m m v v ti w rn,"v us w L. t, m,.q w w
�� zE" o,0 v 0 0—, ° o U.;" o 0 0 �.�.� o v 0 0 v• �x o ro o.c G v o U v o v. ocm,
wiz o o > rt ow. > c. �c ° � v °.� ° 0'3 u
o > " •� vo > ay c.�" n > 00 v c ° wo Zo,EodEU4i ,, v
ca
■� •0 w 3.0 � cd ,. �by 2•;"� ~'u''y y �'O-Q Y 0.- p'„ O C I.,.4-,ad y y�.c•, v, •, p,p.•-� Q 'D 0.x 0 aj > � ° 0 O y
V "10., .•' ••fin ° t.4 ,°. .4 m a y p rt O `-, 0 s. y,•.C' SO w 3 in w t. '...'4-, O y U O v ,0 1,�
d w y, on rd = N ° " O..., a,w '.. c,) U U.°. ..0. ° nS 3 Nate+ U.., ° O O v v `+,�
CY. 3Qy � 00ow 0ad ,_ , Oc°s - � > v -b ° ° �vvv (y bq cv � � vp. 0pva�i5 Cai .C�' o
�'W u L Q >, )Tcle bk�y ° •0'' .ct. U'U-,...., U s. cl act .�..i v 8 s:0� , 3 1 �.v a.. a'0 40 L. U "'AloG 0
o " v 0 1. >,+� v U"" v, _, ° s. 3 i. y:d N,� y �. v w Q cC O y,� P. W 0+
i.w•.. ,..a-O v -. O 't7 0 Ti ,. ,a v v, O c� i. s. v s. 1-^ v s.. .."c O EC O b 0. "" . .0
.r'. s. CI)A•.. O w.>. c5 ,.. Y.,0 Pv y ... E bll ,n.'".: 0 v g 0.'. O cn 0 o O y 1-,,.0, v ° y ..,
U A EQ v a o
�j� AZaA V U-o.p'a=.c �w-77 o -o 'Y ao'� ,x °�' mac,y• °'.y 3 a��,°a0, v �n '� 0,u,a a��i'°d o•`»y 3 dQ °i C
Z rE�'�• m ,. rs'b,C E v v'� °0,�O M cC s, ° v yr,'N 0 v 0+0 Ct ° v 21.4 �" '0y u ' ° C °C,y,N'O p a O V.G7 E.•z
M Z ,. .0 as as - H ti'C v^, ,. 0 p v y v s. C O ''' w w
W ,E'«v C/a w v O - v ,-, v'.„ .L U_ ° U_ w v , 0 q O.. , O" b ° O O E e6W ::
zwA �w �( b. 0a.� c yam. = v � � v U c � � ° U � w�y'y ,oi. yv� v v w a.) cviw....> • o
p w w «3 v 4°.'�. ° 0,0 p v co iC •0 ; v a' v u N g.0 c� fr W.••
02 w F n U v}a o > bra d v v a v LID >
aQ utu40�^O OLY. Q'SSOy?'�^^v.,.�y� ,n.Cw `nu a, °M 0� '^v's. 0� ,'�i, �inp >p G'v a) •-' y w •^•0.-,w CL O.Q FL� r
C o w ,. m d x �4 O w.0 L" v v 04 v . v .'O d <�i� � v a" v 3 'C y"Q v 0 0 >,= U v i 3 'O 0 b4.4 v>'"en op•�.
aw le ;�R� oa °. a > c � �yx o 7. o�. Y .0cv a� wy a �� v� �� N �. xOa
rZ-c C1c' a c as z r.a d_ a,Vi c , 3.� 3 �;1 ,, ,:w T ,'.-o ..-0 v ° o v o ' 0 0 a a- e. 0)
C>~ Q p' x IQ°0isrov ,00 cd vvvs .° ct 01v , oa 3 [ vvwy at v vtO +. pF 0
ox y � [-a o� � � v� � ��� ywb > o Uo•� � ° �� ,.,_�b ?; �yyv •ca - I: Z •ate-4) ct � ° > F .
m ,. 0 n , v b v 3 .0• y 0 v, GO 0 v v 3 0 3.,w 0 v7,4 6, 0 v=w..-, v cd O
Utz 00►r � 0p n 003 i� 0 V-0,. ,OEN0 co ' 0...boco ,. comio ,,, vv E aSv v�w�a..1
Z H Z . 7. y ua >0 U v ,. v v ° 0 aadi �y..c° �d V, � a -i ...Z 1.b c ow �.c v 0 o ,,,..0 = ai bn•...: a,4N ctl
G vvscee • >,4" uo > vv,^d > cd... " vU ''iCP sig y.. owUo >„2 ,n � - 0 mL 0.-Sw W 0
" go+ p, F„i w ° `« c.� a _ �' ."•� _�, _ c�., �' v. >,w �' �o ��c v o c s.'° � 'c.. (� a� 3 �yALF a
Ox0 E Say`,,�; . ' o3'an ,; ,,'-, a' � •i, � a� ca ° °;; cn o v , oa ° oU_p Qow+
X E"1 ,, •cr.
.0 O. 2 m H s.. Cy .U .n .c 0 °•.� v v bq v v 0. v '-' y-a 0.O > 0,.,v. ....n'C y 0 co a1'' 0' ,..0 cl ai cn cC ., U v U F Z d
wzQ , ; C “g [ 0o,. s•'".v � a aU� Ua Cy Uo o �Cc a; s, ,. Uov•�,- > 5 ,� O5, .., c4
s. N 'S cC C � O i" .i. u, v v w L O.E v ba O m �C " N.0 0 9 -,"•.�•,i.+..0 gjj i rs w b
y 0 w w W p v 0''
v ..,n N O .°. �+ b,�-O ,n d ° b0 s. c� v, s. 'n'� LP O.�. G `n O pG 0
o E H C.'.� ,.'O.0 n 0 'C 77 t o > ,. ,. ,n 1 Y 0 v c� •'Ts k'n v• '-' O v v 0
w E a H ®�Z' ° o as° u tw 8.0 Z 0 Py by o•r -'a y N v v�. •-.tn-. -. a, " a-•, E a y _a.n cn °�o„, y ° c A a.O
w Va + v ,�,W °w ici �. U N E -a. ,.., .-- # c�S v O I. �' '� � co O O �.0.=: U � O a~i ni W'U
Q W U `" ,0 W. 8 = v, — °.,_, ,-, •> U ,� v y w^'� .0.Z 0 ❑"0 7 ..0 O O v Z'0 ° W b cn 0,p•" CI : v a �o..,7 1e ti
Va 4tt i
.+ E� c.[ ca �; o00n3 Zios"aiov.. R'_" i. a" 0 ° o ccd ,n3w o _ti'c°^ dCd =
,.., > s.y v• w �,.-. U..0 L,'cd v"�'' y.,.y w 3 A c� m c3 U P, O U i, m bq 0 w .. A O
H 1"+ \ ° w6 CJ a. . obi a o c s. s. o a# U w n v 03 o v s. 0•-'., cn 0
dr d Q O cC..�'. v m c� v+-.•.. i.,b O U a. 7..0 U ,y.�. O O v cd m• ai v n"d U v i.. d
Z ,,, >Fu w s.•.. 0 0 *. �> 'n U C3. ""'.� « cg.-1..,..."d 0 ai:b m►1 c+
N,,: .,k
bq v s. i....'C uv-' s. cn '++ v, v O �': � .0 U s. .�w d O Q �" m 0 v > 0 U 0 .. 0 v U„.� O.. p O >,w i„ w U " aS ,. .. 0 �" 0 J'"..1., O .. �'.+ v C A by V1 a .
g �1E-, u F .. ,. I-, �°•0-°.00.' , °.> � ta �a0oa,, en.000•� at..,� r,o4 np,= >,Ev c/) y,.. v. y },NaaXie. m
m (A 07 as .5 . O2 ,n ,, v O da,..-. v 0.• a vL7 0 -" = O ..
wa '.0a d.0 r, 8Uv >'0'ww.� uaE .. ,.�. 4.,-0m,�,•., at vio.' � ,,� v dw ,n > ,.. ai,pida � •v � d
V9 uOW r3 W as ° " � � OOU'.7 pw_z ,, ., Ova, bD.� vv00 ,. 3�'b ++ cd y'OOm CC) 4_, v wE,y„0 C
~ .0... CL O ° '''0 0.v, ' ° v^ aa) O O ° 04,.0 A U '.�+ I. N 0-r"'.,,,A.O va .. N ,n 0.0 .0 P.c3 w0 cv c>0'b cad.- ° �i° , el
C4 w> 0 � a0 � U . -c •c.G a vv .c ,. m3 on... a v-5 .c ❑'c
0 O u v y:b rn'�-' ,. v v o O 4_. . .4.L'w 0 0 w w .' >,0 ,, O 0'} O w v U 0... 0 C cG w W w
A OVJC� 46.... ��b,zo mZ0.cd� QvvU.., v3oyO o o > ,°Cp0 •... o.4'y > 00� 0.. .-. 0Oo.c00.~.� mw'd
d m>+ 0. 1`. 'l L , v > ti T w .,. •',� O v a, ,n > v v op ct } ^, ,n O m d
Z 0 0 0e4 �QQ"" '" "`� co v1 v �" Gau `-9 ,nOcr''n °v0 "0-07i , 5O , vN ' re, 'CI �� d ° wbA" a' CL'
d 0 p 04 A 0 co,U v •� m.Lj y.. .j > v. -d..0 0�, w,v.0 o 0 o v ao•. ,0, ,vim, a'rp•,v A 0 ,v.,�+ ,. 'b v,-, bq p,v •'�z
w « .. I. BOA ' ,, Eoo 0 �y•Notii. � oy i. 3 o0a.^ c a, 0,, �jU �� v'G o ('•° Oo '" thQ�+ v
O C7 �" CO O..., ;� 0 v O c� ,. ,, ca ,`n. a'" ° ,.0 0 Cb ,, >,,. bq v"0 03 ° '"'> v a,t�
A (4a. , ^(`noo .� '.... ,,,., a) 33ov� v s,,4 vo 0 ova a , , vo o ,. 0v , v r vv '. 0. Zo d o
w v, o >w 30.^ am P.P. U... 0.P... v,'0... 00 . ;..0�. o � otix av ,. o.o 50: .. a .a