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Richardson, Joan Form VS. 61. 8-16-35-50,000 (17-1423) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT ffilir 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.... .0/ Re istered No. '05/ / (/ Town ?----../L___ County V illag or City (If city, give street ad ss) Name of deceased / Z Single, mar 'ed, widowed, 7/ Sex. Colo or divorced (write the word) Date of�D�eath.. - 19 36 Age` Years omits 2"--- Days_ Birthplace��es�fj'y''v �j, - . Cause of Death �, R-, Qs�¢._-., ©te---- `'�` ""`" 7f 71 -Certificate was signed by v4d'".—v't--d 4 / M.D. Address Y. ��-'t � 4 .•� i'14 1-1- Place of Burial (or Removal)....�..,��- •••••y< (If body is to be temp "y 11 i space later) - Cemetery Date-of Burial / 19 (If body is to be temporarily he d, 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 frt.!. b p,f Y GRANT A PERMIT /,‘14- //' t to r .. ........ (_dress. ' the to hold tempora - n the body. n( or song charge of co we ove, or oth tspose of [state how]) Dated Q../ 19.. (Signed) Local egistrar 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. Z F O ro z v- c-'— En -:N, t, 0., • i. Y - pi).•. 0..)w A cn Q c. ;cn cn 0) 0, m w y ,,,,0, .4.,0 $.. I.:a,cn X w W'St Zi. o.0a, 00om.- . ° `," 000 u N.c o UH o oi.c'S � cd.y.y o cdp,. 8 e ou o ...v., o 0o a • cd u cd 3 ,IF. 7. O 3> A6b43 , u o0 a �.O >..� 0 G� 0t, v , ,d o °' � m 0 v vaoy Tiy ' � uyy > a °4Y� 4 Zy 'a. Ovnu oo°z ° aaOay 11 o c0, u n0 4a1.. ti ... v u0 c1 ° ,. Ui :B uU O aC .�.�• 3 �Y ° o. od 03 CO ii, po On'03 `OU0 ° a.b 03 , xo • V.. wu,; .0 .o-oai vGvvu- y -uwv yo 02 . v. .-O G a .5 ° 0 a.. . o (ovu' , � . O' ' Oun y . y WcALY "M . o�-uZb O vtO� 3y � - u� p u bv . O c uu oNO � N^ ' U�ia 4Z , �Oa 8 m G u t, • . ° t. .n0 mO c u u iCu ° > a., v,:0 > u•. -C Av4. O,, ,,. t,Qr y0C` gCt °' o '" bd• , zaa$ c-o.," u- ron~ oyt. � ug .9,,y •�cd > u ,«• w " � t~ oz .�+ 'O - � `� or ,°;.b� O E °i •.!dvb 'wi, S liuI41! j!1i; W o v. AoGZcm0 do .Co °a ,O-N ° �° �y u•u. qF. v ,. u.-- iu.n ,n .Nac. z r �tO-' pzWp (A'C OiU0 , }' •C. * 03vOA ui' od ui '- d [ro ,, •.. t. "0, . 0 tioI0 ,° � d, Ocd ci -. t* " ci• pO02n p 0I- o u, O do* 0-3 t,-S,-8 "0 , uvvm h0O 'd ;n�C O C. 17. dF-0 . Q 0 d.2. .- N'd -, ' O'Ua . o y j y a y d •, v «7,,•N n•gi bo cd 4:ab ma tu O A v aw,, biz) i % . -O u t ,n w °u yGyi .4 d C 0,� ,. _'-. tao,� aWW v' Q " uCU 0 v 0 y O u U'c7 co ,d Oiu, 0 ,Lyw d Ow U d t, a•. z0a+ O...• ,a+ U , vGO 0+ 2 tx 4 F.. ..V E� ° tiz , Oz � ° > is cd z nA O ° ,d... cdmw.10 'nC 4 (I) 6 01U = b >w �Z Q4, . w- C > -,=, > n -z- cd °� iO . ,nt, vornma• ,a . . va.t o1- ro .a t.vv, v ,, E62d o� OxAvWlt ,4U 6 d0 W „ uyCC'v,w.�° uvs . .•Ca,..n.yybv e,•: O cUd vc,, tU, u .o i y b tuy > F"C u •oOvcd b4 y U .O7V O MI u. 30 u. d d ° O .. cd w 0, q o ub y i• ,n > .0 O v. � ° ,,° m u. 0 o o y°' aoQ 0cd ic ,A_� a.cd p4.� o b °•cGy Uoc.Cbv. ,•WkWat'LY Q 7 m 0 ° °- ,n . vyI. c 0 oO.u.. 0 a 'utn v y 0.) 0 a°w I-) y U — O c• . Y .. v H °v•0, +ZO a 4° awUxdg0 y" :•0 ° y+ 0 >,T °on° p•E N.y'+°• >'r'-'0'O'�0 vm3' 00 61 C yd• y,u r �>+Qw?• V" u1 ,d'b. ,-, v Mb ov �01 O o A o uao n,o a ,Fd 040 d b � . b� o ....4 . vmu' „o o r i,d :, t y a. N u� n o ,m u o o " nm am O av s .a 1....... v a a Z a Ov0.,A� C.y v o .,j v [-o > v., rn 7G A'-G, C°oC,O o a v � cd�wi v+.. cm t.A.5 •�i hi .aC Qvdzw a,vi 1< uox > y o j t a od _ if),A dV 0: HN Ow a � oco �y.� ° ,, >-- v a 0 O• ..C• ., U" l t, v, p.... U , O b0 ,'0 ° -' ° b u °i , / u wr OA .,� ao ` yt. 9 0 0Ui0,0 , I) 0 .L0' y�. v ., -• t,, v ° 0 udo � ou•@ aivo 2.a . a0+F.104., � ow3ot, 3a. a.. aa u aa -o. 00nt..no