Hillis, Anna NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
glir 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 Oi-
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No... a,O/ Registered No.
,.ounty ... .... ... VrlfirgeVOr It •' (If city. give street address)
Name of deceased )7i.
... .. .� _
Single, married. to hewidowed, /� F a- "19-5 I
Sex �_ // Color � or divorced (write the ��•ord)��/t... .�'.4-e.Gf' Date of Death........... ..
Age `- is YearsG ,\lunNths 7 Days Birthplace
U .
Cause of Death ... .. ..
Certificate was signed 0......�L(t�C-e, '� ..... ../. . V./ M.D
Address .... Si L��X �
Place of Burial (or •emoval) GClt�t�.
UU ., _(If body is to be temporarily held, fill in space la e ) ,
Cemetery Date of Burial /4_'Q .t... � 19
(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-
ion, the same appearing to be COMPLETE. CORRECT, ANI) SATISI".\cTORY AS REQUIRED BY LAW,
T have accepted the same for registration, have recorded it in my Local Record with the above stated Registered Number,
and on t e basis thereof I HER BY GRANT A PERMIT
„. ..,,q.(:,,(_:; )7 ,/ ,
(Name) t (f+ )
t ' 'r to hold temporar '. Ks the body.
(Under er orAlerson having charge of corpse) ter. remov otherwise dispose of (state bow])i)ai•il ,e,4 7, 026 z 19 3Y (`ig1e.
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.
^ c .,.� , ° tea c » c, � oo d•ay o� �•A vt+ yte t % .10 * -^ ° 4•M•.•$ Otte,-•
�._ _ _ = nw : x ~ ^ `t oG�0- -1S n 'AN"S•n Ai0 N -tA+ NOA -, S= C '=c •�f •O ^O' .�'20V nK7V� g
rri
-2.- - _- - = S.., ,y n ' SAcoy •t ..A ntMW A O 0 O'Sf0D co, E. GN ::rD < GSA Gto -_ ",' coco, d0 "� ,� S41 p
ZS - -� cv= s A _ p p ^ o >2 o
+�� ...3 wxi `" A - -'w �•.< nZ.cw - r., c, _ �' � r`� w" 3 .,p.sy NI •yy ft' O
T y !_ _ _OO w s .g OD A C -_. 0 -•.V" - n n.. . 7.., C - A V A. K C N », 0
'- A 1_ - -- -' -,_ '• _ 3 ,+".T - = ..,. Al O -^•n g7 - A A 2 � 2- ,o O n..y r 'O S •^•.nT 0 y'• O
^1^' •.� .. ;7 p-' = ..'n i. .. - ^7 C _ ....C :� 3- d e _ _ n _.p, c (n -` .1 5goC C7
K f•,y_ ....
yr. :, . = A n 7 „- _.0 tr K =.`+ A A A c - - - - , - ^.n 0 ^ • 7.7.2 b �'p+ lTl 0 �
'0C- rypwry. 11 AGr, vA —^ -.0� _ - �~ Nc, - - r = � �CgX S`.�� m b�
�' �.A�7 C ;�7.^ V)r., g T :5 ~ • r. ^; '-.,:- r 0 = _- - n O•< A �'a Ss' H .Tw >O 00 ,�•- n
. J.... A Q.»• y_.QN PO = y•TY 7 ...r _ - S ,,,, - _ - - - _ _ _ _• -A�•m 0 A = < A n+
•- • - O ":'. - *: "'A =.may _ • ,; :i SSn ,. T.3'ta,n
A» �� 7 - _ c�t '7soSzzpn = c : a.x ._a *^ _2 — J—= —_ ^ __ _ _ _ r2.y aCri7 rri Z.' AZ�l PomPt
"i _▪ rr C ^ '` c-, - ° c - — y A s� ate- : - _ -r - _ _ _ _ A rX�,� w $�'0 T- c -• ;x;
«l7r a" A �ti _ r _ -o n7 a H2 A V3
.`1 v. _ _ _ _ _ -- r_ V
"Cr _ 7; A n.L7 S�y sue, A 5�.. _ —g `v ,, - - -- - ; ...-,... ..A 0 ^ ' n
70 iSt y w A A Et.v. c> a_...-_,,-,- - ; rD W T - -C - C „y O ,J /��
%11.4
�C - - A - ^� r. y� A .. f ^.� n _ - - % - - -- N 0• j r. ."h' ,, �►�
7.
"'3d• -. ^ 7r.'s•j 3 C A O .. . S? ^A SE. 0'n C ri !- ,.... _. r _ 2- -_ _ A q rr w S.w•
0 3 _
TtZ= - r A cA C 0 y sM , -� ' _ _ - _ As
01 z 'gyp. \ I�
til
:1 Z 74 T _ G A .�. " n ri = .. '•r: A ! c Q! H A O w•C _ >H C7
7, . — - � awro � r o � ^ » T cr � n n ya — _ _ • = S xm � � 3c rn
A-1- _ _r, C nArD ,p A3 - n wA W ?< a . � _• y ,. — _ _ • _ " a m.Oi,A n2 :,. y O
Gi _ '� �' S C3. rip �' _K A r' '� O04 rt• •-n A •^i n - .C-• r-1 C17' T O ^ t> 0 E Z r'1E — _ ._, 0., Ah•o '., 2•O .C.. AC = T ^ _ .T 0v (�J�7
-4 pi ▪ ^ A a -• o r, A •a "n a 3 w : r= : -, r a r - - - - _Y = w -n s p i 17.
�. "y"
.A.. -• • T�Swn .C.m• p ,, v' D14', (AbZ _ �'bp' •1A vA - _-7J • .. .",e. < .-- US 1..,b�j C H►z,
r< - r^ C .SC d0 O A ^ O -I A =,^-Oi - n`OG OQ A, ,� -.» v7Y _ _ - .n'A C`!•C' N S^ ��.Crl C, 2 n
,.z. _ .'O � n Pa 6 O�, O�, .°•,...d= � -t C_0 0 0 0 0. '� -i -,"� p ' ,. 0 .a• '� •y E C =.c,), ' A ,�+�. N
/J i _ .. x•5 tD A N .S7'O * :.. '„ .. - A .^ »•A co D, -t o '„ S
D A't -� 3 'A' � pfD,� rDy �. wN. - sc•d� o�•: y_c .. , c-, _°5.-•"-, �.. .'E m" 'f
f .A. �� ..'0'0 rD -•y ''A b A S ~3 A n ,▪ ,,, "W A .' n y'."' n = (..I'S^ i. c� ^ ''� O C .r• TA A A ='0A' ', -1 E w •O R o M3 - o . ❑ o "�IiHiL79ilii
3 a3 p „ 9L.y ='p C ., O <OG • yr O O •t' �SD�, CoW O 0 SSN 7y'C O 'A• O :Y a O `.' w 0ro 0'O O.▪ T . G.N ,� A O H