Thomas, Mary Form VS 61. 1-23-35-25,000 (17.5154)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Dr 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. / vt-
) Registered No. 2--
Town _-
County (. l .. Village ;i`' A- -v ,� - `';» 4 ),
or City (If city,give street address)
Name of deceased /. ::.�:,
S' gle,married,widowed,
Sex;r' - '-..:CoIor ✓ divorced (write the word). .. Date,of Deat "--- 19 g
Age.......... ... ..N) Years /0 Months / f.._.Days Birthplace.. J:.
Cause of Death ,..../' ��'"� f_...._
Certificate was signed by���,l : Z �� _7-.P..S,4-..�. - M.D.
Address L ,
Place of Burial (or Removal) L � � arr ..7Z--cz-l_t a. '
(If body is to be temporarily held,fill in space later))
Cemetery G .e- .... ..eeu,` Date of Burial a- -, 2 7 19..:7.6
(If body is to be temporarily held,fill in space Eater)
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 c,
z
to r 7�, :.:2.." f.-,. �„-` a.-�-1.."" ..4...... 4
•
(Name) , dress)
the to hold temporarily and .. ... ..L.,- the body.
( ndertaker or pe son •ving charge of coryse) (Inter,rexpaye,or 9herwise dispose of[state how)).
Dated �ss..r^^c�.r 19., (Signed) sRe%' - � .2f: _!. -- r.,e.r..?.R. .?,,r..,
i ,, Local Registrar
T s Permit is sufficient for the Removal (and Interment or Cremation) of a body to y 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 61 O ° C 0'• ^`+ to^:"C I.
aV t. C.O'" v' b ' 0 w O u O t.....:m n V V m'w v, '"' V Ow 4-4 - •a s."" v"�
wO
DoO.aV0doc • oUcd p oy p o.°.::.0 o V.: O Od . ni O cd ..o O V O, , o ' O.,.. a
V• CA z ,. n , .+• � cd cd >.+ "C V V V. T ° .�P 5 . .., O- O ,. w.N ,:aoV , Vy NO V �p° , "'� 0 1 , 3;• rg o V O 0cd >, y -0 a) rn•.0. �'O •. ^ 54 ... O O � .o s. Odi ' b . IOo;
>y ] 7dNW if.C4 as V V�~+'bs~ 'O cd Vyao -p
_ ' a kaiy a °y o a � y Na~ ° N ° ea,0.. a= co abo3 . � O Hw o� o c° aa �w � . ° aVs - za aL .0 .�n 0"'-d �„VV.v v a O O s •+, O v,. Oa o z xV • , *+ + 0 � bA m . O wiifl
,cu
o
az
CO/ 3 Q[b-« 3 ° 5 04-, V . °ti'4c oy Nm'> V o„.�baoo aV b °. o > ''' .4,, II > ij
A 4'v M ii
'i `nVV C ." Q-1'a Q >0V.,ybA�y0 ." ,, v. uyy2du ,. ta.-,• .o-od F sOVE a`v J 1"W 11>" b tyV " ,. � o,'a' .v..11VVm > A 0 s.. , ,. , r . T .� '7 Vw C •o a'.. dY,
bi)
bo
•
,IA,., , ,> w O o",-, 0 °b + 0 •��►-1av Q ,,AaQ p w:L,4° >, 0N.� o'. s. ps.vEy•G.- o0 -, o•^ Hv, mO O Vm �"O V ...5 ,ow yao -0 s. -d d.o00 V o� ° .a.0. •bAo o .1 OoVV u, V . 'Z' 0A4a V.7 `nG o ''+,' b Y a t. Vri V t. V O•o a•0 V ya V ,„ ,_, 0„.., „,— nd..m -m. p .a0dO 0 el).., V 0..,LH1 m V•4 cd'U .E� U.a p •p csV ., a) , .� v NV O ° . aws' •+co2,wso mV 0,, a+ V 0,-V, ,..,-. N nrVE� N V V n ,6..!,)mo � _6w' VV.an pWOW c/) "-0 i-0 a.4yua, cd ,d.°t ni V.9,.°.V p ,;".V •OcUd�d . � V >WhMd d dVbVeV . . „ "N O °.. d a L. 7,a = y v•"••-• 0,•• O..U' Vy �•yI. y0 o Zt
g g °.4 I.4-1 7:3 p b [ '"g W N.- u •
O � V OVN �,y � O V Le E.., c V ° . 0. � u 0. ..,m;. .� t,VO ° ap'"• ff -x �.0� d• Qr. ° �'" "' p QWAWEy cuw op , . V., cd0 t..•-, �.' Q r co d s .0� o p '+Q
s a0 �a W ' es o a" P " >'o 0 co V cd ,. ,-, z y-.-, c `++ v— O -. V'O co `n 5 >. O w u
_d_ m o d ,, 3' u .+ y4-I vb "[ V0O • = cd 0,.• 0.. O 0p,0^ n V ,
d V-o .U.oO ^ cd •�> ,"Vvt, >, Vd n t. O a>. 0,. 'O ,5-. V -. ava , md . VdO ,,„,, 000
o Ocd O,. 'OUt. VDU .+ E ° ni y.� V ',�.y '"' o oo•..C,n• ,�° d a-y.aV.F. N , +d.ci3. o vv," 60V cdy > oVV'0 mn S-..: VvV a/�Wfayo JS . O % l CV. t• VO m V. U VV > Oa .F0... + . '. -. o V. . 0 0 E Vr o» a aa � n YZ,,Z j • 00 >1UVL .'ytdbV.'O,z ,0d � p°• ° a as% V ... 'L7 d "" Ua ,w.. o. V WaL
Err v y " >.- zr V VO.. >•+ V en
•
' > t,... WCVcda>.y04d eF-o W O3U4' zUa '73Tm of 0..7... O'i O A. Eo U'O V oa ,.aO- -o. bA O p aax¢ J� aE m0. H dhama '�yJ" , b - V �y +' ca > G ^ N ~ o N0 Zo OU 'a C'' y .,-0 o 0j C. w w ca. 0 s....° V V qy•b 6• ° V,,, o,0 .V lN4)• .ctO ° d-... cd � .. cd° c, O= CG�EZ d�yyQ 4 UZ , i ° '" ,..,_• > cdo,cdU,a s, 0. ,-,ya Vp O .. d Of U o .. cd > ..� _ ' ct,. Q 'JW .. c "aO H aO.,, aO am . yO O V .a .a 7,a .,r Vasd yV yO � •'i � cymHy"c7 � Y ❑ n. k A'OK • . w.., a, _ OV - 005 � O^ ° > 0 '.. c, , �Tf. o `� .�-q'O.0 O Nc, V bnG . a ° ° en y o e3A
•
W W i s H • (J"-4Ldo ''° WV.-9UV�OmZpp -. .H dcd °. CIF-I8V. OV•.' .� 0v v° •E•' 0" Qo z•.Ca s �a°a. , ,.0'C`0• ztFO 0iOv1 Z co y Z W >, o. . n O °-, g.- . i ,.'" W # �y' 7V O " ti ZU° n C. U. V O V CI"0.+ iW .,w04 do cn "'y y , 5 > V ,V .ti b.° a . a V GV •.... m ny �. •, 0ocddvo * . C ,,x a �." bpA °'vo p n Vd �,v . •u .04Oc cd'�'0 da 7E-4i .i3 d Ei 0 › ... - V' �' Oo U.. S.. 0 O U� O I " 0`4..:74 Z-° icd , MC"' V00 s `n bA .+ Id G'ar ;aaa. bAm .,O - s. OV " 0:::. ,yNo* .`U� o v. m cd �u y0V ° - d aZ � > d V ".N C b.. P u��= . o o Q3VyP - g °y , •iCE 06- ma `W W 0o� 0 � p ° o VV o
15
•
11
1.
. ` soCdFG 0 ax Cn0, a '4, as d — pacum ze° z«Q. d� U 2tx .„.oF v. ,. py wV � ,, � o � noO . et'. Va U1 . sCd ~w aN: 0y �c ,, C0> o'Wa+ \ cu �d: Fa �v >, . .001-- ..1,.0m °6' ° r� „ ,. :° '. 003 _a � �' NoH � � �q o , a . 3ivAU b0h > o O ,-ydN O ,-, •bA . V W F,a 0 ' dONy ti . •c 0, aj Q -ds, ,C 1-2,A 0., rt, ' o .wy ; poXd�+ i
•
s.
w7x0W .0 ay1"wU ,., •OvO0 v oas a ^ ..O�"I O c a m ° ca O'er '"ti w poaNU.o Va . coV •.' ,, .as b... obO co oV Ty., 0 0,m y •.V $. a2wO. '".,2 ,.CV Od w m c., > AU,. ° " > O48 VU yd "' 0 d, WdW.vAoz
0.309
+, V1cd'0... t. wZ cd., go) , y v , ° q ' .a>,0 a •" N. >,0•d ,so ° VO+. i'wd 01i ,5 � r. V 0s,':, t, p .00m� > 0 ,, °U .Ottc0voE.,0iaOa -:a0m ° � ' q °'7 dQ<' "1T'boEF >• ,4' 0Aan OEM Q -7T ,.> '� , gw0.,M E NpAza
co
to a » � 0W ,, d C wA, o•m a� V �6 �.0-d > 9, .. � o�. �°b° _0002a `°',., .d•,. „.'".0 > '"- Eba0 ��ia ozI ., o � ooc °, , '� 'Nac a, aab vV °.�.0 °, oa,oao aebn4) uhU ..A ° o a0C-- = C00m ,. t. m .- .. a 00vVdwVa, .1dw 5yot.- c......, 0- .. p V V," ,.," °, 0 ,og 0V . Vo w" ,..� 08 s. e, I. Toai I. ..>Z °) ta" 0A - -V3 a o .. 4-1 co 05 w 5 3 0 ,. 3 a,-• a ut a a c,... a s., `n'0.,. 0 0 cn ,..n,., 0 cd.0 0 ,. I 0'O ,. 0.0 bra::
.11 a ...1