Shapiro, Barnet Form VS. 61. 8-16-35-50,000 (17-1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ffor 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 WRI r rbN IN DURABLE BLACK INK.
Dist. No.' 19/ Registered No. /0 Town �/ SO 1 �df� 71eA/ i1 '1 ,
County GLG Village !v O(� J
,/ or City (If city, give street address)
....1a24.1,0
--i.-7-,i
Name of deceased....��� , l
Single, ,
marri d, widowed
Sex % Color or divorced (write the word). Date of D t �s/ 19 3l0
Age .la...y Y ars /0 Monthsy.... --� Days Birthplace
Cause of Death r G: i-‘T�c�
Certificate was signed by M.D.
Address 'w/..-s— r.. . '
Place of Buria or Removal) o- <J zX .0
(If body is to be to arily held, All ' space later)
Cemetery Date of Burial /6.1 19 6..
(If body is to emporarily held, fill in space later)
The Certi c e of Death containing the above stated particulars, having been presented to me, after careful examina-
tion, the me 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,umber,
and on t sls thereof I HEREB T A FERMIT
to . . �iatte , ��
d ress)
the to hold temporarily and the body.
(Undertaker or person havi g charge of corpse) I remove o otherwise dispose of [state how])
Dated - 141 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.
r
Wy ° �� , o ° 5.om•O a�•oE o a)a�a �E °;�3 � � ro.�
a ha +yd' OO� u v 3o ^ao
�
v
o
a'�
cl
ill
Cdpo ,i3)
, o0o � > yo ,. o o, voGxo Z ,
vN vO ° tiOt, q.A .. a0vcUvL b C '. 0Ew E a,,E •,d,'L vE , >,r. 3O 22
u
o o' W a aa5 ' 8ri b ab a° ov v,=, a>,0r.�v' av a-a >v. o oy:p.. v ovvgv°vi. av >, 2 sn „
- Cl v. t~ t°N o t� v4v wu 'c7v dY aUv .v ° aa . b ; "a� ' ax b mad� � a�y � > a ° ac aaY � iW G °W -« � bn Eo� of y �x aa N " v vaE >" dOdr "P. c ..0pa va,. o v.. a
iI.,• bd = ° O E O ° 3 O O Ny i .d p O . n o ca . .... Ar . L. ,.O
3Q13 OEw v " , v vc o . EcG v .-e•N "O ° tt'.a.+.0 0 E 7. vQ . H CAvbpa °. i. ,~ ° NO rs Ov v
� y .0 va ° t � ,•r
Lii. i +'pf
® Wa+ > i. : , - >y .+ .j V ' .,• ° bn T3. .. V vi ��d�;tl ° d3y � � a a ad d.a at 1` .. � av,�, , b n `U q) E<4 o.0 ''-o, >,vv.� ^ . Ebo � aabp>,j t~ ; w a .' oEo ° ayo °' .Yaaxa Z A V � — it b . ..C v - a, y b_y E._ E °'4
o o ° s `" a, v >,.,. . "a yt%j .
_ b. a.. a ,, by , „ , u v aa, bp a a. t O , 8�8O• 3w -t QzE"+ S,
. ''' Hv6 E•° V-O , '6t ''1t. o N ' av O... 'O v it' .48 � o ° 50v vnc.wSH7 .0 r vbav° "yw � ° a �vC , yo, aw .Co .heta'- v '. v �.y-- oa � v i. w • cL, VS riw et
W c �O Q ds. ' '� ° - « - No> ' E � vuNav & - >ow F , >,- >,vN,.- � o ,V ° VN ,moo . , - .. —; - t. E dvv aao.+94_,' aV . .Pa
•
tAcg At2 a Q a O v-: .)r''O. .- w v M ... E ry % O 2in .5 > >.-. a va^ . 0 c. ^ OCw /
LT4a b ,t0X E � Ow-Ei vv vvtvd '' vvO �+ vot. a y .n z a > v v. b b a v�-' . Zp W o • O uH av oo'' a'.C. V v y c.avm.v-yaA 5. - v .. .. Q.Cv E-O a... y v tiw.0•Oa. oy >.'m Wo
y v~ A. ,C.J .cva � ^ ay1od:, v o ' QwGS,ZW , cauwz a sO, a s 1- = ›'a % v O -1 v o-c-C.. t, v t !C wvea t - °va 0, E >,0hW t
)
a py V, t'C4 d da-•. a..0 73 s, .a t;vV-o .av v p •3aE O.y•- pa a'yyvvnor, u - 1 tev .'.V.-[ O .4v . aii..-O 71
H .acIiliI
iI1ivi
; O `, cd v v v "°°H � . E ab� EE. a miv 2< . E� 0v, w-Sa> '6 > u, •av �.y•C Pa" dOx0 ta, F'g'WO. v ", P,up . > t. E a da ,,... dVo v aop„ .6bpgE ! iJil; I
ce t.
- .. co AE -, ° o v aEboa ‘ a+v • v"C - s " - ap.. a °p v •74
'W £. Q;w1 ww ® ° vt ' °'v a v0..+ 0mcd Cvn ry'' , o vv " ' E v h0 )m16.aati � o 0va'O c v3oa
GW , [ra ie,ci0 •- '° '; v . z 04bya � a� v vm ea � � vm 77 a )- a.a v73 o a o'dQVLa V o Z N dZ W t+D. •G v: O pugl aE-o. i, O E aycLe•z v a .. ;;. � >,• ,n... a a°"). 2 a'4.E ti00 ,. i+ . wa ; r. 9 wO � � v • v ,. �•b t v.O yNi >,v O aEE ° a0 O v,O d.E"i v•. ° v d.b , .a, a
cr,
P.
� tor' . E,,. - > , vO O C c c ^d !O a.,i- E O a �s� v* a�:da.. q'0�i.0 bA N � t• 3w-GAva p•V 0�t/1.r... y U ° , V +- a,Y UWw4oyy .b°i ° oai oou. � c t. G O .. V a a r do o � M� p °
rZ*' y ^o c �� d a d Q E Rt.4 ya, d, ddo a � ti .> i � a3 w N.� 6-,, : 4,4..tb v d c . ma
�W °� pGuw, Ev � ,. 6 '^ �-[ C v . , � � � rd " o »• u O ] °NC 00-.4C) w 4-. 0 -4q. Z � Oa0Zg � H�.V [- •.a tim• m. 'p p,�O vv, p •� � I'd a im v C O O- cd'^'•._' v'7,•• a � >,E (/) t..m u• w U . S.' X 'q >, '0,, td yd v: y a. iAvZ w
n MC a aQ p vv . 0 cby O .c m4a .CEas „ v.vaaiwaO v .. .0 t..-.. v- m .' '. vd" i. « og cd i. ,,n it °,,wd d � O� W �` Wo' ° ^ u � , , o p °bt�0� > � a d � � vvO,.� ce � + '>'aaQ, oe,„ a,° v3 Vay
•a eea onNta� ,,, A v ea a Q0' artr bi),24 N E'.o E aet o ea Nb�.E x 5
Q /)0 V aa v i, , 7:1 aa wv •� '� ,Om3�. 'i . 't, p O . u .-... a`O 7. " wI:.+ v vw+ O uv v.. v,a ° mO +. wV >,a °O _ .A' v.-,'� 0•0 O.k .vcd aQypY drw.,dr7..., . v,Zz y y
O . •.1 Ps•Vti ° i- y y O a.0 v ,a' cd> ,nhwu E d^-a O v a., wP > v . ry CO A t. d N d.aO t..0 v, m e1 k+en . t. . i. .. O O 0M ° a• . .=' b4tW;bOt "0 yt.M Q a E ,=..0"0 v, � bA . d...,,4 " i.
04 °u C4 L .v' col Q v OS > ., v dv -• v�, m25 v ° o °b Ca lc;� av-Oav: C t. b c. i !Za
A y „oyA tEaO ,� �.a� O ' i Oue * �au"�• .ap , i i .c V .v ° � mb�O0,7,•5. 0I-__ < uwAT �v) ao °� o�„. „.0 � v O ., s, cd � °, v.°,N " .C5 'C i.0 'b"'a ° 4'> vX
.., .v, 'o.>, 33 a .v a.a av a s v... a a'�i,v.E ' o,7) i.' °° o d. o -o V. o.051.1 .9 a
4