Le Febre, Melina Form VS 61. 5-24-35-25,000 (17.8593)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
filir 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, LE IBL 'WRRITTEN IN DURABLE BLACK INK.
Dist.No '6 ..T Reg' red No.
Tew
County _ _. _......._Villa�g_ .... '"Y,,,.�C
, ( city,give str t address)
Name of deceased.G� ��...(%1 e /�,e-'I�.X.r .._ vt
Singlied,wid , �
Ese
Death. vv 9v i irthpl e of Death �[. ...
Certificate was signed - M.D.
Address
Place of Burial .„ Ren al) '
(If body is to be temp -held, II' p 1 r)
Cemeter ... ...lie.. , Date of Burial.. 19.4
(If body is to be tempo arily held,fill in spa ater)
The Certificate of Death cont ing the above stated particulars, having been presented to , after careful examina-
tion, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, .
I have accepted the same for re istration, have recorded it in my Local Re rd 'th the above sta Registered Numbe ,
and the basis th re I HE GRANT A PERMIT ; ,Ct_c2e-t1 j, -
(Name) - (Address)
7{/� to hold tempor ril nd / .... e body.
! d-rtafcer or sorb ing charge of ) Inter,re ove,or of r ' e dispose of[sta '.ow]
Dated.. . . . if i ...........19. (Signed)~
Local Registrar
This Permit/sufficient for the Removal-(and Interment or Cremation) of a body a tfart of the State (subject to loca emetery
or other regulati. ), unless removal is by common carrier, in which case a Transit Permit (, No. 62) is required.
09 w L. �CO ro C/J i . w . . ".. U w O s.- m rn U U v,w w_,;V vi w.4 . t ......
cc++wO W
bQO'C ^wOn' -ON O U. w O�•C ° O. y O .yN O. ro'4 Q ° ro y O ° U °", s ..
0.> y�q i.YY mro >Y bq3Os ;7• aYUo a C
EY•� T O >,All > - .2 �,Y0m ot. ' nvro ) a) 1 rom >,° 0Ya� � a1> Ewa .° ° o ==u3dY ,.. vO ,2oo ro > a :..u. W2GG ; 0,0 - 7 -0oa) . z - ,0:oaM6.0) :a' P, 8� EI)" E °: :; aCDdt
O •r c ba ;--0 .---0 %yAwO) yw � ti �Yi',� " • p x, [ >> ,p.-n. 0v .... am G O m + ~ bwCLas U � i,Qd
a. Oa a� CCiaYb
Oro ° i ma L Y 3ma smUy xo dOd4fic0 � ro }.Y °Y o Y ., , bY a
OOW Xo ., s4 , � ° ropti0 ' U ° ° M3VC•) OO ' O yUvu O'Y Uz41
� m . S , mC .tiyi-. a.) U ,. 0 y 0 ub•+-' b 0 0tix t7 • u3 " w +, mro > U
SQ' ° OwPa) " (,).GP" 0 . yr 'ba° oa bo x mO 00) U wy we�.-'i m O1,-d U t;b} 'C .0 s. , +'yO C,CY4. aa
4a
Q •^ Ap.„ O Xroca�, V 'O ro c" % P,ro'3 +-' J='C.ro� ° U 'ro a `' cY z I. a, d C
1.
tj
hio
a CF �G Y • � vi b0 O s • ,Y ,. ,� N PI-, >,, U � � O"d Ox .. ° >► ua). ••^ tl't W'^A Fa O U p'C A> , ••- yt z .L m . a C.> O N . pYy ^drUa)4+ >.-. N^'ti' CO U m Az w � c5nc.aG.� c� ^., i--i "- FO ` O t-� U..a),-i P., s. G ,p ._„ - b0 S. . � U p °,+ rnNyb,-0..,• 'JdO °' C 4' isC '. U . V. Ja o•.Ea VaN m ^• ' p .b � � • ="Am� a C . U �. ,, ..,. ua Opw4. � . O OHUcaa.,,. . % p ,,,-. a ,,,, O•„ E ,u.... Z +�-d HOZ� m l a �+ O , ° > .�r 4 OM� HH"r .b a 'C7U' U.L U „•ULUYro. sp0 U.a a+ U .N '' s °.- O ro a) E„ co W ',+1-4Z 4... a, ,4 U dYU U ;N ... 0C0a•. U,.. v ...0 � U „a • RI
Z[5~W I-0.4 CA OU5Yc3U.� yo ,.ch 'c7� ° yUro..ro mYroYo a Qyaypy cum <2bc4ro . u^„ ,W c W ..i � � � c ]> '� %�'," p." 3.`ny .^ +'.., G� «W o >ro -' � . �•^ ,'�' °u) a1 4 .sa a o F•� U�'m 'b.. n 4.C=U UU biQ Crc3 >,•.
•
•
ii;
� � Owy � ma ro ,,,,, a ca u i , , �a„.� U. ^ ° O OU.Cro"O 3w"d. O �bAPxro.� 00zWz Cla w yxL, O -a�i 4a) uU Q Pa)-, 4aH y.F+ Yd 0• --' ^ bro... ''' z :Ua ° M'.-13•.m„ O i Oa
W` .., 4 u E•0 H"n a) Aa C,,, a1Yca Ya .Lp . o, . °y • U - s,. ;''-' 4aWH it.u"" n'sa-a ti >,c rop mo ... 4z0 - .. • . ,,,, . c4 „OOCV�y W• aoa °'ui I. - y ;� c1-0^ic) � O •" E U .COY•. a O P G.CCd oU'' I.
QS 01Z i 1 E� tl ' Cd :. � sHn ran 0P. . ,. ., ro V
1.
11. 1
OW .0 " U„dU > s, ° U_ �, ;~Q w,,, b y. '' w vU ti �"",b U•-' roO U V �'? ca ..,iroU0•Y'"� P OO Z 0 X. t, >V)E.4 2
'� ,+•a a, H,i,.sm,-ro y,U UYro•4•i.1')7--wg U.4,,n'Q C).a U.n.. ro O „, o -[ ro , royro UUE uU.-. Ug4WC4 �OXW y'..u, ® mw0 O UC..o - •m, 7'Y O P3° ro Y ro. mU asU O s, T 'g ro.ua):„OY U�.►.H...v . ry'- . p as y ..Z �'d ca aw wUa, O ,Y W W U ' s > U Uaroi• . � m,: � � ) ,' ro O ° wi z z;' � UO,,;, > b U. " O ro� .aq'C' Y b0'b P, ^+' W aiO O ; ,.oa & E~d W O • roro'= P.,.b'. 0 - ETNvi4 zi.Y"d C4 „ UU . y - O UCPOov .O 0M /
ed
•�s�.ai i 3 �C P � y. ', • '� �> � U OE O O aiA y ^ a , UOt P v U" 'b m P za'�m
PI
�
Hd O .1 • 3�� ~ Ym ° Y,i, c3 ° s0,.,U�'' , Y0 ou• , ) b c , , m „.; Uz '' 9� n
CA O ag n,. W roc o a roZi ro o , Ei U. '- m N a a • z •Oo a n o,.000
O O u_ b. ,. O 1, b0 O.± yro U s, • ^. >..- n � O % ro0w s, P ... w vo YYo3 a.s ° ,n Si`� , roY ,., >to 0proO .:.- uN ° uCa�YIm9 da;Z W >. Bcm , '- U PgwLga � u-dc `4- 4 U ..Y,^3 �71 G U-wW U ` � WOCa' . . 0.t , rob * F,-,.p * - c5 -3pa0.° b0° im00. w � a ro � " FOg•o"
0o , 6 O U 0s. ,w. O 4. • , caUca P,m U H m b0 O'ca ,' °i ,
00
+' ro ° U L. g y:: m crE C!]1-4 a."'eG"waOO ~Y V. roY ).. UP ct � U# � UO• . O OWW t. , tea, C ro °• ,-,-0OU ° � C) . ro•4 • - U -xbOn b 4 y2 d Eb uU oo . ., sy.:,'I,.' c) i OmO ?,Y,„ a� UQY c F, E ' A Oi � UC, a11O' kac ' U > zU ..2Oe) PU..,.dcaYYqci, R7wca .wro w„ ma) dcad oPmYU.. ..-Y • [)zdW tr0a E)„O,O Q 3m.) i, mU p.0 1 �w rt m ° O - � "'' p•- P. �p ai wtr=: bA.0 O ., dAO U > P• „ Oca . ; P.mti•Us,o"'' ro ° UiayUa •; ro cu� " m • 7 g� caq� UUw�QI .0o b U,' , NwDU� . . .. c) MOc bOxOma�C) ofcromE Swct Y Om?+ �,O � ° ,n O Uz C4 uW d� oP' N0UV•".'6 '. 0NP•0Q - =Y 'ya.� Y.a.., m '.- a, om-cca . , E~ c,›. GW , YmUccx P,p .2 cJy.C ,, ca 5,.. •N YbG•i P p.- O., OU .- ProW. �"ww P,O 1. bUU ,., �w ° O p� > U ' O' OD � a slldi.�A owOu ro'bUYCUb.m 7OProU UsU. O = O� YpU > a A . m,••�Y , ,„ m O y °YPi,G,� P, co Z > Cw >•AO ODU ,ae)c oca > .. ca y,^ U3.Cr, . P mc,.m. c5 3+ .dO .7 Q.0 w a) O y,�+ s, py,. .0 caO v T O.. p � . b0OD.• O c, d Y z.M ~"'0 al ;C b0 a) b0 r LY r b r i� . 1.1 M- " U t U'^ U 71 U.0 m• vM N..U, . '°Ti i I-'M T .N' m "WU, O -. s,N•' s '� _cb0PZZ .1 '4n •• U -0 > a). ' m O Y'new t0.= P roe) s. N cd.. s.A,ll' .S`. . L. U.a P 1'W O WO � AsZ ®A°1 yp C) 1. O.,. T , yp ,.,.. >� O « ' o4) ayv i. zP U UU.. .di O �, O X u w.0 u O a) Ozc cd N � . a A � 3 �^ `'y ° o : a� xaa ar5-- oo' nO o � oixg �a :° on' �oZ^ aE+°
74
LA.
iiltz ..wmOw3 ° 3a , , �.� co