Nevens, Edna L'VLW V J LI.,VL. J'V•JJ'JV,VVV ,srJV/e) •
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Qom"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..2. J.`.Z.... Registered No.
Town,
County —
Or (If city,give street address)
Name of deceased ........ ...
dA�. Single, married, widowe ,
Se Color. � ! or divorced (write thy, rd).. .. 4%�/ A Date of Death... — / 19 (9/
Age 3 5 Years If c2
the 6... Days Birthplace
Cause of Death , .. .1ca
Certificate was signed b 1.. M. D.
Address 's
Place of Burial (or Removal) --Orr;—.C. C ,A•r4f/if"' 2/e444 -
(If body is to be temporarily held, fill in space later) _
Cemetery ---;-)-z>'r,„_......-.‘,( Date of Burial i— 19..,3 7
•(If body is to be 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
Num , and on the a 's t of RE Y GoReENT A PERMIT
p (Na (Address)
the /� 0 (z � to hold temporarily a d .. '. th body.
(Undertaker or pe n Zing charg 7se) (I er, move erwise dispo of [state howl.
Dated / — o�C.. 19.. (Signed)..
Local Registrar
This Permit is sufficient for the Removal (and Interment or Crematio/bof a body to any part of the State (subject to local ceme-
tery or other regulations),unless removal is by common carrier, in which se a Transit Permit (VS No.62) is required.
• °.. U ' 4,c4
a H• 14' 0w �0.0400 •z00' ° 0o [V00cu.. 00.tY.:00�r a €Vg.0 ° u•"V43O yW ~� , n > 3 = vc • ►. aCO ►
cL• av - p 3u L ' a " iv- ° >, v4 >Aara 0o0o 0 . ,aC . p11 ca0Lc .- 0e ° cav -• opCo'- coa E3 03N 7a GC � E L 0 ^ ... N.G.^.' s7•' .._N �ya vv > oG . L o0 00 > ... .W .zW v ;: Vd G► L oa �a ,, ov L.+ Lv 0,o,. ., +
C. � v � •g� v '-aWw. A a v Ay ° �� s -°o�� Aar � os° � ° . v ba•= u -g «° d0�°tua �t s0._ a Ov� u � ° ws3No � A
T‘ 4 _ � co � -• ° _ W«0E, oaw - cde� ° ' ao" 3� u•o• op . « ELA '�z o0v�vsG > ... aGvv •'Qv' ° cA' ° y ?° '� ° > oo a•°�•��. °: G+' , �a Li v 9Lo
' vpGG. «
L iLvo °. g.".L Nv 28
aG.CB�N BUO N °O -+ hy v ► 'L > b. 0vr O
� ^ 0.. p y co v) 1- • ...N « ai L '�Nv> w p . yVtJ C w
rN • MwY�•1 .7 , �a,W . -. p ` erLA � vG p. c � i ON ° LL Nv >> . . Zv" 0O s v .8'Cav �� Gc� O: Nv tds-7 .- d . � �-
F+ if.
GZ4 1.4,t, 3 U. v'7.v G:••".0 a.--'� L.. v'7a ctt. o �-• x vL C3 O. ^'7 - v � � O( N O ,y,.. w
v O'.
p
" I. N 1-I -C 0'Vv J p O O L G^ O vNtG 4c6 4. v d v« Lv• Uv : = s..• u b.o 1 -
a�
N0N � r-, Hv '7 ►. a0 A.. N L V ^ Lc• ,, v04 L- ov a.., -0-0v «. E Gv-- - CI p• .«x `"zW v � 1-� p + by yYs ' - v" CE '� . ° Oo ° v v � ay . • '2eruYvvvs o- - 00- aibop v ► 0OA 1 V�.4.Nu Md V NssuddV�, p.,OL s ,3 ,.. a y« . 0vd " G nNL v0L E�
17
Vba pEl a: G ►. fd >,vNc4•vG) 0.Nc. C a.- > > C x O�gQ vQ �Ab , v-' °% ,2. + . v Q fd • yC L « C a v V V 0. yw vV W #
( . .iN � N >.,c>d > . Gyv - ca.. LL 0 ,4x =
LE,WE t-t ggN g�. O. Fyauk, O•wG : N v7aL cd N-p cdcod ^ ►+Q v v L . - Cs3 �+ Ecd y � o cu 7oLbos NoW
.._O v. W ►.>, F" ao � G= vGC GO;to. Y -� sv ^ a� b '.. G v L O cd•„^, a' .. > ,>ra vv � O v.. d « ., v« .. L vYpa -v 0 al sv CL+.s Va V, N ° > a'iscZWRe 24' 0HP+aa CII 'O.aLO5L - As d-s L. d ,...= sL. .„ v= Lcda_ 0E. G.n� L .03N � -v '. Oc 0 . 0
.." ► wxcy0 , vov., mv ► CAFO �o. �fx1..1 tt▪ pzw r-1 .nai �•7 ' �s23 <,1 •^ L. vv >` cd-7sy0G Bsvvi.. o.vE z „ .- cd0a) Pv
O Wh•.< � .. s by ►. 0AV � ..� . � Q, � ( . O�p 0wO C • '� � LvW � ►.0 (rl4, � NEv v3 -G'% v N °'G . .. w0 t. .. o .... v•.•
E1O ..00 ..w+' Y� O0 ` vvc,, 707 , -.. � y tt_ q c 4VG o t wzCvUw c itZt-4iys -v,-,4f.- -"a n0: ^L a e ` a....n_y�4.- v O rl ). dNa, : cd3 "4v^ u �.. a.
Z,,Nt/ a �N Wb•p ✓ N• aLLv ., i7•7 a L C ai . vc -v ...� F'c7 cd v" Os s v >.-O > L" G uNi b'L-•� v F O.4 .
O 42, V Y... dE" f-« •..V «> .i0 .. ., F.
O.d 7 y Q ► L o «L• bo va� Gs a Py►a LEs Y4cd W 3a cds• G-p > oW-N '7,.,v v 'G•L G Dv'L--d a;;o � v +�VGv aN v « ° 7-aG _C'C ° Lu-A.. W id�0,finE-I E-1 ,} u+' cd -.i , vbo` aG:;
L.Ur0 H c0FrivLuN + ^ v va, . L.v . o ••wan v• : , � V ,.0 '+ I-. ° �'D as � . O-. am N • u� ?� ^ 0 • i. asv G o 0-a ai. ... • �• A A'X` �, a ►. v�� i., o•Y Od OGc . .> L... 0 p o yL O� v ►' O .+• Cs ai v•- Ni v N.. -• Z Gbew� � capW byV v .°Y �y .� pd v - v� �yyLCNN� �« «
.. ... , •• y0 NWpJL. L � v6l . v > y � o :e "3aU -. � aa � ° ° .-O^- ' At+ ��aV]0 + .faW � ° � Oa bo 45v C; vLC.. s-= y p.� G • GviGizi � g ® Noo ►.Aai _ OcU � V o"--
o0r E A .o„.�a. a°.t), 0oocdg•7oL* gua•G b�-tva,•a a a.5� 0G1°v'Orvg)§ZNcVp.bY�•U�.% w Ck.c .„ Clce_M °u
Q•-• 0E..., ►. ••
L L p 0 - � .. c - d v v ►" N 0L O >cd [ a ,
g.,+^ �b o•- O --- ,�, O O v �GL- .. ZCdd 1 / w « UOCcd y • C,.., cd p OO.-) 0. 3 .«N a it , G> 0c 'Nvv v.7N.« ., .,•p v cd aai•N z •.
! ��W C) O ►. ,.,.- Y ►. L L.G- V vii N wOv O vw.+L yL " « cam.- u .-- 0....-
, ►, C s '.7 'er •
bgno_V]C N , C4> CvavO a, 7 ,, . OG O ... � O v ,,, «« O. . V _ L L
to w + i.;. vLv•+0�.0XIcva0 > cd.+ �40V, a ° � NG0., ~ C. > OOcCd14W .4 44 Q.bp ' FV •. � Ca co o 0 N L U o 0• =-'u-.+' ,...a....43 ° cdG �CO ,,, V'• OV b7'''. �=o sS X pi
✓ rn E' ov GV)`... llv ...f, L„].y v'7 N `4, ., ° v .' 7 cd 3 v w L x( au " WN 02a • cdpo - ,.. -. a. > a a,.n s >.S a o s7v vti0 � (d L ZgXN N a d . vAu LNAd ^ � dC o U EW E,.7 a, 0
Nomavg ° G0 V� a, 3 :" .� CpQ .tC. ° -='0. vW o,, ut.` L0 v 0•o"'c s vySs. o v «' , -so L c"c 7-0O_ , PS
t
�. «v +' v v-v. ° GN.+va. vu.« ^ 0c, u ° AG: 0- >• uo >.^ v V7d avGcdL ► cR d O .d CO 0) c ,, vL v3 «•y cNm> _,, ' p.., . 0O p• a0 .4d0 -. > 0h ° so 4) cl ' i L. CS ssN� ., .O .. OboNza�ya ID co � W O/1 � L0a -• Oy °v Q. a. a ° M Gcdi. 7NNLy' qbMbG V . • >. v ea) '77, ►,My v p ai O . . ye."
° m � u � v ,,,,F•►
d °pgiA a �u a�� 3�' `°'o0 x y .�•�.-. �:° co,ho O o z`°'L ' >, `°' ' � v, a Q,� C ►. p3y - 0: bo C at s [ rL , aV , � � u u. ' . 31Z cuw ^ W441a,<4 s.. o.yL^ a4..4 5 ^.G t,, d o�cdN0as - L a, . N s �7'oc. to a) V >, v LO
v ,' R"G� v ' °' ° I. L x ° L . -.« aW A .. ...5 v1E+.A ..,�'V' 0 >,2330 �: 3G� GGG ^ N .... co'04 00cnLaw. 0of.40i: 4IoLoato: .,A 4