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LaPell, Elizabeth Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT QM'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 aCOR- RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No._t !�_ 0 i Registered Na County ate of Death_ a - � — 1914 Town, v il- p�9�GY�C Q- Sex._ ._. - Age.f. _Yrs. Color `C4�:u Mtge;er City "' fp (Cross out names not applicable) ) r os. Cause of Death .-... ___._,��4 -unc `-7 --- -- --. - - - Place of Burial 4,4 �� Q1 Ce (or Removal) -- ���'�- "- tery .Da/te of rial_/ s__ 191_.1¢ A CERTIFICATE OF DEATH of 5� - __-- / (Give.full name of deceased) having been presented to me containing the abo 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 s�taat�ed�RePjma's/tere Number,and on the basis? tth�erre�o�f,I HER B BY GRANT A PERMIT to_�� __eGetA.rl.�Gij�7/vs==-./.___ , `e�1/ t —v' �[..-Sir��� " )7'( . , (Name f U k �) `S the __ _ ____ _ to the body. (U dertaker or person having charge of c9rpse) (Inte ov or _ rwise d' ose of[state how]) Dated____ �LQ �L• — 19Ag.'. (Signed)._-. - tO . Local Registrar This Permit is sufficient for the Removal (and Interment or remati n)of a body to any part of the State (subject to local cemetery,or other regulations), provided.th t where removal is by common carrier, the above Permit must be included in the Transit Permit. VI ° ° d ta co '� do '7OfO IA ro^Q age% okti_ TO RaV•N. V '',,,0rd.Otil f,� ta' dro .,c^}m 0 o„ �" o w d•. o ro-7•e° (] ° r. ° 1 1� *d°d° morv1.a""• w d ro°R• 2c;5--oo oS''' sn "A «' C' V 2•10$1Pv,00t S...to% "e•-• 99�6A omP.ddmp• �Gel$ IA m om v "4# yy,, G O°Rd ry r"m m �m'✓ C o is P• "d'^eRo y�ro"✓5S tog � "`to�y� m �' �. 0,0 ►4 ti w ro o l is o o o �d d o kl•�,Q o y•6m 4 -%.°•_._.o p m R ',, t� yv1rq ,aap, fi�'n:•p.y$ � 4.•. ^'' Ry rodro rcb O r• n' kn t•t m•, © '� ?•tN. ro Rm � `1F d°a oR eA p. �NW K .,•e rA togw 3a. S.t�g 7• ro Fs d� w,,.�ro °co..,d ro r, �y to 1 • p R ro ro ro R`A .++ O H .° Uto R✓ro N N tw�� , s� p" 1 gA e G" ry*R• Fp� R ro�dQ���,ro ro 9 p • ,t 0 §�i o �Ya $e,y�9g$O 0:-,,N$ °R0Am�w3 :Gacdo.`tot:4a' A 0 o rpm �, 3 758 p y �+m4 o�NN dG °✓y' m o"' `°o r�o m c ro v� a rd m ga y�y�vyr d 7-c° , Via- ro .; °a 'G % -s El K S ro m 4l @3 S3' ,.} tt ..Y+1 l� a�tA s zs� ,a✓.NO,•'o�im.rm O✓� "Qu� 6p m a..� *a•mRi°ro % 2i M m i Cl e.0 l o TOi�?Q a mO dm d.N b o,� n G 51.p�P°1`.•. qi 05. *O m , , ..K ro 't t oa 9 1• d m R ry V ro ra'`h or5 '0. m,%`✓. 7• t,SA: ~� d o., n ° e+ `� '(�.A°, 6'�aett?;:`•O�%�ad.'%'o""''`t � '�m rAtdm., .. V �jO rop•Zl '`a�aR1rit%1`" .0 ,'� O'4m y y%oo r�..,, 5 ,m+'780rN „co!,, �t v w.t..$ o0 ,4f0N Ka n C✓•br,i,Rd m v, 11 W t Cr$ 't `°A,r .,. ieot .. m` v y mmanR,ndXto rpdmmrodd K ry.. y 3 *1Gi ° °"✓vm H roN R q✓ romro pRmp d✓:✓� t '�° �rOTrro an d�.� m "q S �mR dmn _ D"E '"'dr�K N Oco `^ ir.` m �o e*Ksroyy K acegoop•5b F V°%tp,row:' °.e°'�m�O ©.Fo ld iA.�P 1 °•4n 'o 'w°...°^`c 01%.?.ro cr o o..c?.. `VO IS S. A 9A 0 a 11FA1 to- d t,. ' t • inroa�y• �; ca fin . rom .•ag�M anN �r�,„,; o to to a ' T. inR oiw"°m6ro°r%yGr "� %GCR�m. R ,,"'Al , $ °a: t,`7dp CJ • e or. m di m 'furoR1�R`�. i �' lwo' moA .o4Oamy°"sm „d dro a .t% ed dYlmoptmm'�� oo p.rom'400R °Q�t`3'"' NOd • ,� m is✓.Q not t Rd ti ro °`per5. cxtw 1,0 g°m