Selleck, George Form VS. 61. 8.16.3 5.50,000 (17.1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fillr 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. rye f Registered No.
T��_ Villageown 213 -0 o � �,f 27. 1
County ,� �� --, '
�'/'/S�r- - _ or City If city, give street address)
Name of deceased
�� ngle, married, widowed,
Sex...YyColor or divorced (write the word).. 4 Date of Death /-e---4.' 2i 193 L
Age 20 Years., 7 Months 3 Days Birthplace �Q''7 t 61 o —e... 37-72f,
Cause of Death.... -- ciC a . .
Certificate was signed by - Q M.D.
Address �. ...
Place of Burial (or Removal) ✓••• " '
(If body is to be t rarily yet, fill in s e 11
Cemetery Y' -w Date of BurialXel" /6 19.3 6
(If body is to b 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 basis thereof I HEREBY GRANT A PERMIT
to
-72-e,t,a ji; ,e ) 27-y,
(Name) t:� � (Address)
the to hold temporarily and ,1'� the body.
(Undertaker or person having charge of corpse) r, ve r °therw' spose of [state how])
�- . f,t,/ 1936.. (Signed)
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.
":
• Z.3[. 'O t4 f'� >°.v^°° "w cn^;,,0 '.' ,3v a. .0 w
O.a vO a O ca•i U O U . O O_ O " . . ..0O .„,�O OUI
.3 aCn 3•_ 0 .-pp>,
.h0nv w ms, - m�.yv w m�;,!0'-' cal ,° tv *;•3m x
p
W
bW V �.' s ,
fihilli!
oo° E•o1! o " E3 v l av >,mIlL
vo ba av v bd.r Wy/] '° d a ° ° s v c.v LvOv ° ra vw -CI cv vOa Diti ,. vva °� � a o ° t .v �W F. " O v = .-a w o.° u.c N -) og >,"�0 � 3.y3 � � ° ov� ao�. 0c�a v O i, C 3 .0..»a 0 °G �a-� CyyU\ • dQ « ° wwp1. ,.. 0 > UAp� v _ U ,�"C F 14 yQ ° � y '
v IyawW� ,.. d Lt 3�xv A �b � vC a"°
0a) 0 s, - >," y . vvy > q Oa5 . '_' bi:° �va: v � �v �vv a).., 0RI0 a a�ay'^� Q N40
o ,,, O ° . v Ii !
iiiI ! 1 ! !II!
im v . vanv° ..a vm mO,. ox 02
•
W N P, s'pbwv ° 70 C d d ° o "-' s. u w, ' v, o w aNw.. • a `r OE" '"'•ZW ` ,o �'« to vv.' 0 vy ,,' c .,, v - o ° ° nd v ~ ° gz' , o. '° oo flogW .
< WE'' � o � a..Ycv vv � • ° v , oGo6 ix° u_.a my ° ^ : .:� � ° vvu � atw ° ` ��n›Gi-o
d^ s. d QIIo '• ,, a.UY o.• v a.'' ,, S0.. 4 >,> .° a tv, v p...c N v Gw, y to) dGL, >vlGi - v vC. Oyv, . cd Cg W 2 It; dj [••1 , OyiF vv�v t � NOvyc' v° t�� v b v,,n . ° .4 . o >, . uyv ' 3 .0 ° av^.. Zi
� eozWO�, v . vo �o >...
[.4 o ".CmF ° v o oyUyro �.� �� �i � - A v b i ° �Y ° ° hyo . CQk. aa Z[4 • a- - a a - �" cv p l . y .y .-' N ry y.- 1,y u
I—,a mC4 d < dO cau w - -- w _- v v ° t � '' °ou- c w 0.� o 0 v ° v � > O '
° .. oC4 Q d .0)-I Io-,,'� v .c ° . v wto'tI— �'O�sF ; oa° 3yv ,;.c . avE EaavcaOi..v,.01-
Oo W � . v °x � v ? > , O v wsO+. yivY•" (-c . a v "0 O' _ , . 'L� 1•1 0 `� vv 3.� ,.°•. ,- . N. v . v f.. O • < t0,r , Ug ° c .... v,
u � " , v o >f/1 F
C,yc wc b.° ... Oai .-0 .Ev •,w' d ca 'd i d 04VVJ >'U ci) Qp; !�_ ., vn .7E.4..,. ° o ° °y m v v v . 2 . v � •v )0 ._ ,,CialCY.=:z -p
`' a4Ves.° , . N v � v y v � 3 � vca ) ^v ,.7 s "° d y w 0-v v > O.0 >, ° V bA,-. fa v '4n14aOod .. da 4, . W 50 o > v -o > - v ^ a" ' v0cz,cv
•
kyadd xa cdA.,, a,° o3t � E.° ° v ° ° 2 � n4.) 0.E 0,-O °� t0 °.° 3 - 0XQ E -h._, . °,- m a, ,,1� -, o. v iwv v' ad "' oa al v •.▪ v a ,. b ° a• •- ° 0c, _ n0u y0O .', -•- c 0 ad vv a- i-a-a'y v a > .^ "O•y z E v ° $. v^ RSv . ca 6y0isvUFZyWz tiow ! 34O O. i•'c > a 4aQ.0 " O ° . iOa Vov'rc y, N v.., 0'[ G°G "OA v fv. W' 44 8v 4a° ° OJ U^ > v-' ', ya,'bA ° 0m L. p•0N t,q • d N ,I) 2 730 ° ° al O ggQ P.* Q,,w0 - a.'°,O y a"'O. ' 0 , ,,, y GF � v ...4.▪ � ww aw ° v , a4-. =wW F To� O '° v v to�- Z °P, ao -� � v ca ; : > m °.� a,-' 0a a � O a O�0 -
•
A
o
0(4 a 7y •iZW i v, ,i � a' s,v O.° ay�, m yb* �UcLY . >, �•. E c Ei^ aOo ` �`4..5,ZtW
'
, �s . W..7t '° O a . E > v v s. d . . pvo ° p.av °. c . v a; v.c mWWVa
.y•mGt. d " .ny ca m , v � 000 cdcv� ° ,.* Ev.E -0,- ,..* a"y.z-° o'nu.� booZvu•aow,4 °.n va -0• ' 00 41
, .py Oo E Vo > s, Av•^ . w LaO " Z- v ° � 0Uoa N Na42 B. . 1: d c m4'0, 00$ M " '" " ° °' * (Cd) O'� ° v •� tivi- v u, g 0y " Z ".:c 0 < r> 0 av .•s, s... .-0 0v . wu, U • P,ry wO ° E'' " cd•",v...Ht Eab0 v;d piv 0.7 wL W _ ,„d) O Q 0 : ° v ° v ai O v'° c% o..o O ° w w U ., . " . 0 , 0.0 7cc'aU 09,p �Y N °a d•."••G a E.. V E•q ; , p�-0A wv p .,,, v, N C O • cdmw,.' vv ca " 7 $4al ^f4v v� , Y . ov .
4 4d � vccao
Zit3.0u ° 0vw �;•-,0. ,.•0 . vRy 2m..01- v � '. « m v tiv > „pd0 `U04 Wy � ,d0' = a ° �� � w � � ° C � ° � � � � ' mx G ° y � v � o� ov ?Qb cA° Nbc . m '° 0 ��uu,
• o , -0• aa,u v y-° ,, ca 3 • a.y pp.., .. ° 0 °b' I.
p ® u .. a:-' • ,. m+•' ,. v ° w .0 4, . a U ^, .•. v v'C. ° aro Q 3 ° . "'C opc1•,, p• jvc0 ° o /1 H•.Z d. ip O . V b'l . i. .v,Z u '-4-, aY c., v .O0O ° d ,..0-,-., „,„ a > , o, � 0 ° v yiW da 'nov
o A Q v ,,,,,,-0--- �y ° � vO � vro � • > rW5advarZ � �_ .� ° N .0 � � O
,,..) ,., 0° ° > vv ,.. �'7v.a �'2vam -0-o. �c ^;bav� ; ' t0vi��- 2 �" u'� "
4 7d ° a a,�
d 4 X Z O AcmLn " ° o v-cw 'ti7ov ' ° a c .v.c-O ° na,v 0 a cm v,m'. ; 4°i u'n• .a..0 "''° v.tegav� du O ,. O ° vx•7$ . E ^ � y - � .,.0 u . aE c' � v.. v ' ° • `na v > 3o u v o uo ouv . . �o P. ua° ocv �Z. a s.. =. voA o a a o 3. o' ° 3 y 3a.� a,. aa 0.° a a.c 0-0., oo.� ai.a•.. 0fa.. 06 00ti0.nao: .
a 0.4