Gwinup, Leroy Form VS. 61. 8.16-35-50,000 (17-1423) 0
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sf'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....4. 4 0 i Registered No f
Town • -
��R�trJte�...� Village 4 —
County (If city, give street ad ess)
• or City
Name of deceased
/ � , � gle, married, widow d, _ g
Sex! l2K_ Color. s/..S�Lor divorced (write the word). Date of Death % y,*.....19.3... ..
Age 41_.3 Years ,f' Months .42—'3 Days Birthplace --{� �- `yA AKA.
L %�/
...0--:&—. -..J .... ..... 4 �I ""`••"�..�Q�`' KA.
Y O00
Cause of Death G�tt� _
Certificate was signed b�'� �"� M.D.
g Y ....
Address " -.
y,y
Place of Burial (or Removal) /7"'. .. ............j..... •••- •• •••,0,. •.•4 -9 ""
(If body is to be tem `artly ...1/4 space 1 i ��`�• � lj 193 l
Cemetery .•-�,t-k�.. •� '/ • • ••••• •-•• Date of Burial Y
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above s ated 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 a basis thereoi•,I H EBY GR T A PERMIT
to �"` --
Address)/ f/
the to hold temporarily and_. the body.
.E _ e-ove, or oth 'spose of [state how])
(Un taker or person having charge of e) y! I r
Dated 1.,� 19 (Signed) II Local Registrar
... .
This 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.
n
�C i Z
�►14y y O hv'b .w v) -d 8 cty. v^ s. Z X 4-1 to -. v w p m 0 I.-• VI V) v v V)w V) 'v • v)w•� I.
S. v x
wA v O d o cd yam O O um O ° ° 0. G.uvY 0 ..,
.. O °.ccd�•. ed.G F ° cd �,y vv ° u °Y�.: °
poW
d
w > Hh ' '-' •.. � • I'n>
v ° OO " w• yi v y. > db0 3 O , O
v � iv.0 d > O EL) 4
Q W "060 a b n; TOaaa wzGw �N NG " aiO • od 03v ",y V a' ""0 " -0 y -6 .0�o a ayOO ..-, B it. Y ^ I. > v^qy . p "
A� G y - `o p.0a1i 04W a G � i } , O ,, ° Yo Vaway y.�n ^ ova. y . d,, v^W3 .c� . mao vvv 04. G
~ � • ° V al o w G " " Y 3Na w yi
oX COoy01z•a
[.i -•[, d � d " 4 ' �n s d U y °"
3q oo a yaG y c oy "b o o ° .w " -., Cu ° ,y a
0�> °
G
.Gy v . et ai 0 V„—'� bA a Fd54, C },h >,v'v Gbv= sin v'7'8Ocav
vW .. ►� cy "yo �y L d.y � 1.'•7, > �, v "J4 O
•�
.-d• y• ,v c O" � • v vO O avv " vaa
•
a
0. o " .» 3Y "0 "� > ° w" m y.., ° C• aQ GV A a< °,, N OT v zvm vG ° s s. b0 ,a' 4. 4 ▪c v i. 0-0 ga >
rn
o wa ..ai. EG^ i GG•. wOy ° vO ".yv , v� ° .azaV r.,5, a. a > A , ~-0vvr: yy4"Ay.t. may - 'buGa,2 O0'4 °' yv >> �..+ mr•ZF ca a .vcd'b. L b U A O .0 O y ^ ° N .. i. V v .D.'. a"S Q.) v v . Q.) V ° -,-,4 " g GJ� vv .� 3 wgd sM zA ...a O °' H;-i 5' vti 1-. O OO ^-. cdi N °wN 5v a 4,, "-,- O v 2x ▪A O 01U ., O :`iG,a,u. •^..° g"0"° ..c ,� az W ' �
..w^« «. v, v v ' v v.•0vy ',G• '.', v y~ OGI...)A a v : V O. Vw•'N"'V o a y-0
o o-r •d' ,4 a. " �d �d y v ' y " ° u � m y b4 O .. . o o0U Wa
0 C i N ^ W F O C. >, 'O • •� Y •y9 G zav v cdc4 ° > S 556, cd ) " E N u i "Ou -iW.5
v)a ` {C y00a v^. >, .n rn, Oin UNM O i.: O 2y .«,' a aiya~ ym ..+waUCwaW 0. to' Fa"" dNvyNa" rt Nc dcyo "°. y3ab " ' Aoo >" syy ° 3 " o > gy . « Zt
yuwH ° ^ -° Gv -•yvy~ ^ :' .y. • � � uC y "w^oo " bnc �•� p7.W c
C4ZW g ° oa.. C., dv. 0 " , v 0 E-,0 .
g. v QWo " O > y-..F., ° ° y .. � c A w
O41-4 ca
d °a g dz W y ° aA s. G3 w - vv E1
do .C' iQ p� cry.� y� o • �d " " y " > Nb Cyoo 3 w.C. C a vb " m A'
1.4
0., "� o o a ~ Vy ,. Ov '0 V, I, a ' yv) v �Q x �•v F w.G d y C u cd u A .L7 > -0 - v,., 0 � o " d q.0•G ti• v•.17 3 " �Ucn ., o e � , • = "o ,, yA - y a0 0 !;.Pfl•
su (0)2s y - Aa. y.- o" b y dw uvC;4 L
. st u a' s. " "v v " v.o..0 v "1!I
cdc, aaZ ed cd O w.0-G m•u., y ILO� H0m IIWouo > vb Vy " . y ° Uq . wa a � �� «ixE a�'� c'� G•o.°> o3 b �y z- ~ -0.z_ o a ° 0'0 y o0 ho DAl.. F
1.
col a)
X OpoyV . o [3 al QqGou~ C s.ao F� a " v, ~ a •� 'by yy - vA a A > _ey • A ° Ggoa0 v ,,, -W7< v c g,:g01 °0 " 'b ° acayAya. s. ro:du0 ° icdv .- : � ...V)O 2 . W „ a °� po ; •" cd i � n 4 vbv E O , FO. v " O nQ z.. aiy:d N v . - aw 1ro F Cr v: Q -0A � y.v-o ° > Oc m-G 0vu •,,, g u bo,•m ,v... am a. ° vV v,9 0 N a3nW Og 0i°Yo : •• " -' b4dZ °0., 0 A., NH a" % ;?.' - . 0'4a E ~��..rAcdV, poOa� ob~ 7 �QO�W V zs+ tizW a 'C ° , ' s oi i .y Uv y " « : " w i° d dooa-, u O " F , .+wti
F "«W a' F0 � �3 � o � duv y* � :,~v# A.° Od > va 1.-.1 ° q °'Z = yu. qu•=,° ' a -o.., tvg "U daymm VO ° ° ,. E a y.aA �oAu'o °za '' tio a ^ ~�u p •►-, Ya' ~ a o + ; ° u � " " CA > cd c- m ,- a" O ° I-. v b0 O i I C O. =
7 O Y v vOC u cd. y.•. cd ',, .. p O av y O ° y as, •,, iv v-0 w +' cd O v " = ..; m C "c g
WW a, o� ° c 4w• v ., "••..-a u a,- V u a 3 w°� a « ca.. o .u-0 eil >~gV >
� a ! bca ,� E' � V,• " N G v uovv b•y °y 0n° 4V
s+ tlE . " y.np O•o � -o G4 u q ° � " eid• 'u �� ao'tiym.a
"v) . u ^
0 , ° ° '^^m a V v cd a+ ., R o `., p $Qx,
Wa a � oa.�A ^ 1 ,0" ,,P. o � Czt«
CL�W� d"x X s,$ 1 °
' � P318'5vv° •�, V � "rn. va.^ vU aiA~ � iyO �w
, 3ai C 5 ° C v "0� >, ,.G• O'o ",.+ .cbw cd 'b O2 d 0•-:;1 v w G %� w> g 5 a Oya !Ii
-oz. G, . v •• . 0 ,,. ~O " g" ° O v v „.. ; cd W «biA yOd •" o > a„ aQi z . of - . o 4., ..uz « cE° t,< - - M� o vE yAac, movM °u •- >, .. mowcz0co � ,,_.- 0bym md
Cui A oa .0
W p aQ :. coav " o m v -v > v- .y•C V. s`') oay. OCOv " 'c' 5, au, a 0 ° y r " v b a
Vs ul b4 d V C7 " o a", °yG N 'v, ° N -..>' Oyb0y F cdaa vvrp, A v L y.. ho av _.3: 0 v u S Q aC o ~ yA " . " 0 te 0" ov 0 > v o. —. 0.,0 3.Ow.,, •9w3 3 o " 3 a[ Cao 0GO0, 0q .. c-. aOo s. as, yx0a, ys. 0.wZ
a.maa u... P.a-,. ."17... OOi.Aw 0cdC0 � 0bF 0AC : 4., C.
..1