La Point,La Pier NEW YORK STATE DEPARTMENT OF HEALTH
/ OFFICIAL BURIAL (OR REMOVAL) PERMIT
jiff'This Permit can-be slimed 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 ANE COMPLETE CERTIFICATE OF
DEATH, LEGIBLY
n�fW//R__ITTEN IN'Dt1Rh8LE BLACK INK. - ,--
Dist. No:S7o4_(�_ Registered Na........... ._.._._......_.......,..
tbartr
County__ . . .. Village.._ a!22 ..Q/.1/1Qge'Le At
<mjr. (If city. give street address) ..-----."._._...._.....
Name of decea d (�� 1JQ._. ..«._a...PLfLr)CL(J. - _
G/`,'f,�� Single, married, widowed, ` e • •e
Se)(it*.c.oloh at-7•Ga...or divorced (write the word).. ncn6LEea�1.—Pale o Death.�:L9y4Xa. . a 19.�..7
Ag ..__Ye�ar,.,._,._+. ,,-..._..-�..,.,..Mon s.... ..._. Days" Birtheilacc.;,F . 7tO.eC- I f.
Cause of Death.._aW�++ _. ,. .;,r.. 1 "•
Certificate was sign%d by—...... .-•. . . 4 \_
.D
. . h:mss.._ , _ _ _ iYaar oft $trial (or Removal).....yy ..... .... 1.74.i LL( , tt J .n-1-....L04.x.:;‘—
(ir
bo�is to ba n • pace beer) a
Cemetery_•_ .. . . . .....�CJlnt.__..._._....,.____Dateof Burial \L1�B.4, ..IJr�..._._._._.._._._.__19.37
(If body a to be temporarily held. It in .paklater) a '; .
The Certificate of Death containing the above stated particulars„Having been presented to me, after careful examina-
tion, the swye appearing to-be1COMPLETE, CORRECT. AND SQTelSJ?ACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local 1Wreeccotr�d with The above stated Registered Number,
and on� th.e b s• th/` eof I E EBY GRANT A PERMIT 1 ( Qb
the....._........( Y► `��fs/¢p�2/�/.._......._._._.__-to hold temporarily and _.the body.
(Uzttz or p r%na having,Maree of<� � (Inter. remove or oth sy dispose 4 (state bow))
Dat d // f.�4............:_"! 19. ... (Signed)_ . Q4!ra,. . ..•. L.._L t_is r.... ...._....._....-..._...._...._._._..
. ,.Z • Local Reelpy
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to'any part of the Stare (subject to local cemetery
or other regulations), sinless remora/ is by common carrier, in which case a Transit Permit (VS No. 62) is required.
e` fL"J1ZE `g�4> OO"VO ° n'"..°..0� O J 1�C'.-.tto- 0 O-A �L t u_.0Y ...Ea s4. O„ „
L4 u�1E .'12e : ce° €9E :°4. ro�eCu'� ci'.-42 `. R � e;'e�S2 u� u. `oe E.o'EE3E uro >'..uc; n akb
O ., j(_} V1 'O L. �. _dl ! 11
YYLj 'Esx cs ^4gooz EL °s3o 8. oyo' ,„ c � o=v il .t
^_ tl._ VY'5 " V s. .0 ° as3YP. tt: ° p mtSG3 .. eS - n y OC. H S/\ F" L L O .G V :. _ C- u�. Y Y 9 Y C` S_ V .. V G O V u fJ V
�i Ci � :. ..5 r} _, uu C` .. O >,•:: -N� VU- : . Lip 6:-•E -.i ` -J `- ° T 3SA� V VOactG O :Q *i
L O . t al - .a Y 9 G O0 ! '. R ty V ^ v V .G O E 'O C >_
L.) "3 ' a , ...° -o .y_L.c0.5 . tasc Qgu_ ° L �� `u &E°--5.2 A' - 3.m6o ° ` oy yE uns•E I-_" O ec
ZF+ .7 -zit sto Eouso 0 c_ " - y .N rt ` uj.n E' Yu : Lmi ° O ° i .-sl'6 3 tq't
L. S tl V �.rJ y C V °'J Y L N V' = A F = I` Y .'- V r Y -'J Y
G:�3t .. sii r " a7 u...y.•o 04tzl _ z 'sr .. ° �i L $rymp .- E ,c,� Et °•o_cOO as- uE ;, atn °
Zfi \� •
yOrW 111 47 t'149 SL LhVY10y �.� O,JO �' Vi SO � V N yq« GOV � E •
0..V. Y- 6OOL LP ro-�LG_G
0y Eev.ur go ac < 5 -.. T9r^ as�L� ^_ Arutheq °' E_-" o- .5-„„�al--th- c` tX_ as.nv .Y ...- 2-5 z >
y W t `- 1 tat x�+� O"I u ` n'o 9 - u Y St r ; :,o t.g.- u S o ° �c u u a'° 3 c G ur.- Z 0
:t7F aLt rniv'o00 S.L'.° ,u, csavzoicL .45i_ `_ - GLr 5a as•" gel.815cc.2.2= o'=' er0
y k 00 .dO4 'c `".' L2a •-• .- v- cA Ey .Cr ii4) G V� '-c .On V
j1I
1I1I:!
..7 e1- "L '>J3:E3 n-�t .. YO.-��"ii : °L.- .. . ..<-03.2u..F .,(,/�1 , . 0-' u. a r. -v>. 3__ q�yySts3��at '5• C'V.'`. o ii.n.�y �.EV •cat/ v ".- `'r�.�' a °.'..4 a t. _iV � V Y 9 y 4 t L 5 Q N FI t/� -ii _G LaO.5 V JCiVYq.p 0 14 ro ? .r EOp VO•G rG •O . m 1E 0.as L� V
ctl.F � E3.c:ro_'Ca'.''> o3.ba.�� :E' a. ' E.. " Yn • ,. YP cc� o `oes-QOp °
k -527:22 g H E 8 lc
.� > 5 .°.'eY O'pOYu a C� aa.'° GET u .cro .. a a cou -• L
'SG " 8 ° V-'- > 6 5 � 0.9 .. �y Sp p Ld•- a ue .. u-_ '° � n Aas - eAUVFIZ �
4 ,� O 3 - , are o _� Y.r E 2 Y i r thcy O , o rg s y. V.-S-a,..de-ca'S 'O
z W OY OL .V. " asO "." n .. _SL J YOO n ..
n�[n la. h .2 �q� o�s •.. oE_ '" =2 o>y °�co" �u1= n• E•pi V' ., " E %'r, u.E $L � �''4,uoo. c9_ 3 wo x �
-4nSCO.- r � 69 �On F • Y r � VCa.g - T_ y� 4- Ee...e25 n4O.- a°n a,aa7 to
yy `a •Z 6NLyt: as- -dit: :
O E O asA9 �' VV E so Y''• et* SI.=- C O4.V'C SG VEO.aV ` C..A �e Y ° Vas.O-.7". LL9
[il U r n.17- Co F" ° = °'r % u= p o g o E Z mu e.0 3 a a
y� �y2W U .`.DV._ uu c0..°, eL0 (VVIi 1ppnty u.a^S.. OA >.w �i 1° 3 . 0 0.- 0ut. n mo5. t7O o
tl V V C�w°. aro.'^ aL emiasas °.- r OV .}O.•' ]N5yLOelo Q ° 0 ` L: G QV
Z1 9 > cy a _ u.E.o PE_` 3 94 . 3 yO5 ET; EP ELc;ir Es auo . ..At.
y� m$Q asL e �O> auo . o uSS:o!laso� n o,;�',o...ne.ru s cr � E: astoeb'.: u �Lm m "'L `
n h'. V f,e 3 `.- „ c c L- u o b n O- `•-b Y a . N u z o
$oG _ V tcy o- n n ao i$ a`o'^ cc '� �' .5- epS o $ .
nQ. s N -s x i 0 4 T "- N n °i.n 1.V0 .-•,•-R Y q- , a'a = N y y 0, n >'o e. Y d it c es •�y..O( _V
VEW ge3 La yV.- gROO5.- .r..- b_.0 /�j� 0YpEOL VVy� Ce. as m S y{.
x Ew.Vas QeO 6 aTlyV 88Q'O- 043,,--.Y V�Lro a c_i�.� C"asas >,tt: net LOtl OroN = ep e111)urz
�1 /�LC L, B8Or �^ t�iyCxiE9.S 0.p XV LrNSW .- .0 m G7'- a uRyF C9 e..�-
•- 01 V Y C `•Ou 0 6 V u.G L`E pQ,^.L u. V O O g On- .. T° �' O > p... Y V . -
.i _ p pYe K�."10V ^V9.- O r'D�+ t. asOO.j Vc gV3pe - ° a ..y OYtD > 4�- ii GOW °L Oy tCO Jr. .,N 6{i. Y
° C Q q E<< C.a �v t O E i_ �' "S,0 !� V� v"0 t.G�cc V .O 9 2 o a m eol v-. .-}-6�V� a“ -.t�9 y 'C mIce. i� 2 Z�
tl mtlu ,-CZ7 ,Lp o ,. Eo O_ c � .rp � E.-'i- 2� DO t� 0..-F y .. 03'5C>pa Yam'` y.o: nY.t og2c 0 [yp{TT{'•��
. ma hrV S:: O'r .as.. OL•••,5FLty-2" . .. as3 & YGnV L mFp` .. CV .. yOVCVY � c.>zi. G ..
-, -.5 -.) 040 3.5•:'. `O':° 2 t o e. 3n� on, oo.g v.5 c.o.- oo'.'nv oast o .x c� .. oe >