Hillis, William Form VS. 61.
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
mar-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. N ...456 e5-7 Registered No.
County... .. ...cutitou.A......
4 Town
Villitg-L4. .
Name of deceased . ' or.City (If city, give street addr )
Sex... .. .. . . Color . ... . .. ....oSrindgil‘e•o, Date ' Death cde142.4.- c;2.,. 19...d.1 llith. rced married,(writew itdhoew‘evdo,rd) •
Age 9 Years 6 Days Birthplace 1
Cause of Death
Certificate was signed b • .t M.D
Address . .. .
Place of B i 1 (or Removal)..
(If body is to emporarily held. fill in ce later). ../.."-'
Cemetery. .. ..
(If body is to be temporarily h fill in space later) Date of Burial.. i
reful
7
The Certificate of Deat containing the above stated particul , having been prese ed to me, afte ca19 57
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 • ,thf..1))a is t,,,EP.f I HEREBY GRANT A PERMIT
to 49- • i • vil". Qttas A-1.
(Name) a _ ddress)
the. to hold temporarily and the body.
(Uartaker or-pocsoi!„..6.2xips..4.6.0,4370
(Signed)
,..4er, r • . te how))
bated .a. o 19 e 01/ t.
r
Local Registrar
This Permit is sufficient for the Removal (and Interment or Creman, ' . a body to any part of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case : Transit Permit (VS No. 62) is required.
JO S O `, O.C '� O �'w C S'+ O U 'C.'^ b'O 'n 'O'GVT, 'O ems' `t O '^< O µ"' O'O fA.^ .
"3� 7 = inn .�1".n � r. 7 '+ O �°4 ~ O � ?n ni � C• � � nni n .C._.?C ^� ._+.0 ti� ..0,to �rV O .0 VI b
Z_ O '' FO- •• ?`t n ^ O.0 O ^ A v..-v ° LU
>C, , .. " ;:b ", =, a.4 '+COO - 1.»nti w n oO .7 •••0 v' •to < GO. . y p co oe0� Z 7
J` ---nia' w `, n - - 0 .0 re0 O. '+ - O.G00nn to v+ - a0 w_n _ 0' On wD Goo
m r : 7 c 2 w-" w ?L3», OD N w.y a <.p $°n O S-. 0 O ?-b.C C 6 a O n (3''C - '' '�'W' `� O� R..•O.0 f, .n.•D•W.W O �-.. V
-A (17-'�, 0'-- 7n 7 =•J: - '."'� w -1 7..,(8R o,-. i =',C 7.-w co v, COOS 5•P O�3 z
K"'XC - c =. .p C A:b = ',V. c m 6 ..w�' r'co `-00-z,< o.' 7yn Yo•y _-_ 0 y .rCi 0 X w w =.° 'pC 4 0 n CA
o' • nc � w ,n•oayA, .. n.7* -, ocn at ,�.-, ' - » 6.: = = r, $ m gm til
A 0 o w 5 w cco K , • v '+ n cn w 3 a.o o a_n . A �_ -, ' ^- - P < "c ?-..(n a b
sa, <°o c n ....^ n $,e c-' -'o A ,..0 = " c_ ^ - --0' •n c'-' C.k' n -ya Z!'3'
O(zrynpj �5'n »...- 0 ,,,S c'••3 n) ., w n, .. ^ _•o n ..,y •
W _ ^ l' O ry . .-- � � � n = <A ;.N_ � H ra ao mm
..d a - 1.4
-` a w 3 n c'�,n SN ar, n 3 g•� ' ,"n . - r; "C - - ^`c -; _ ' `. w w n so w'w c K A alai' 5 XZ
7aaA = ', w_o H •, so �.0wn o�w _ e _� _ - =' *� wa ^P � .-" =•n , nc°?•n,e " < 5- •- 911X�a ��t
VI" Gy 7 •O G. _.°Q n v' (n O y"'�_ ^^ ±- A - - *n '+ n -s _ '✓••cr r.CI1 ,, VIIL NC," C,
m -c,wn0rrooynws7oow7O con, Ry *' �^ ;.~ — 3 w " � ^.g.(J a afz'o ;; • 'A
O4 Zp m :;• -"0 o f' cc C° 3 _ r.•`< -7•d w',- z � JF 7c v•°w O zr-, F n n C r.-- _ H c 3 m eS
7bp `V r> n w n 0 ' 5 =w 8 x°Q n 0 /• m n n 0,_„ ...n ..�i w O �w v . 7 E _• r•• O O m m .�..,O A Q�/:
^�-- = cmyO„0 r O n -, •On m ^'n `a n 0 O -O ▪ ^ C 70E o. " ZIT.
Z�y - :' o w ^ _ , ^ w _.. w3 < _^ cn - = abn �n _ --- _, � HR _ ns
.�r 6 w ;n n w ern•-+ i- 0 0,� r9'O Cr. •c .. nfR n n -. . D r� a rm •O r..3
�17 O.>S -" : 0 . 0•B'O 7 ," = 7 F^ 3' O -_ w .:..- .i, r - o ,n _ �- Cr-E 0 d.. A .-i Ie 0 . ►M ►.
H7C- "°p n•O.-'- y —si .,,,e..' J-', 3'a _'' -' _ n .< ,.J - .- a ro 'vA y0XXC
'�i C'.. ____•„." g n-.S,9 ..1`< - ^ y? y ^ Z, a w 0 ^ •i =�: 0 .. _ 'i ns O ram•• n_`.. d n g ^m Z 0-,2
•'.4tTln: _ 3 nm -- - n ro f 4 _ -?S7- S - - 5 = = - - r < .-wO ^ (/)r
< .- -• n " Sc• wOO -, 0 •-• . -- _.- - ^ �. �O Y (9 r'. ^ --' .. nto H . a•O
O• ti o p a: Om '� n'0 , _ ' ' �E Opb 0 g ,n F. : •-, nn.� -ni pi- C s r,.r m•z O.=, Z.T.. q - ' 1 ,1
O m� nvo �c� c3o3 0 � _ y ,� n 7' EA A) s , w c a A07e�R 777000
.h < � � � �nn.O n „--, =lg.,� r 6- � s S X B S C' . - .. O rt S w =-< -"_C �bO 'O+ n G .....,la + . m Z'L
^,.,>5 _ o _ .wonncc w y3- ='y• _ '.n " - o- c'y'N - _ nO'7b ; o o-N n . .= ►�CHffF
,T.ZA3,-;,; � iBna...," ... r, E OS n .' Sryc.� Sr- ,Orrin O ? -v, w »n n•f 7,,p H ' 0 ,, ;9 A, Z
• • N n _ . O to .f m;n i" n v w S 7 n rwi A 0 ri 3 b p k O'i ..n _ N n n ti .. ., ••i...5..., nn00o ? nCn, w� n~e � p ^.rom w nW ni Sa ny oA d n � � - 0 `e_ G �• ►Hy �~`y OF
�a n �y, p O 0. 'ti .p ,. O �� . ,_.n O 0 E.S D 0"...... Ste, n "' --r^GSN nr9 0. CA ..�A�v m m
E __C-', - = n b ,~c v. n 0 io o -s = n • , n y w - n + c• n '• ,. C� a 1-
��� �,.� S1 np _ On r, ', np .C .. Tnb •, e, -.4 0 ..,-Gron cl,.0.,�n- C'..•b n'0.n0 ro20 (n2
• 'p s •c n n �, o' ., n y n a _•c
m - s- �' �' o ' o -oo°c .-, new . _ _ 3n.,• n v� n3 ._ ro c < a - _ n G
A-r,7,- BY' 0 _.sc ao 3 o n .. ° - c,�o n ceov s =.^~ w e •- o T n N y 0 c< 0 �:N c.., Y Win. O2
* >o b ", .".. .w„ ...,ro r:"1 ' ' r;:, 2 ', .. .-. . - ;a.a p VZ < v: n n ,C '.� n -, ►�
.A ,� 0,'p n w go f y O �' n ? = ',i '. n •w_C S 2.2 O .i S O =c°q O'n_`< > y n �A
^yc �3 � °' 0^Nc.00royan " �s -°v _ ° ^ n ▪ n ao ; nf9w � vwon~v � � �o"cc E �Y k
zT me o n n p' O •"^ oo ° "- o' �' `-, = ,. , -, 3 ». o w '^ 0 A'o (o " mo% w'.1 14.T zg• C
o' to < r, w'c S H (G ^. 'J. N �•n n 0 .W. .j.E W
0 w 3 c n- n n n c•� 0 3' ;7 - -` 3 o s� =c0 ,e s.. »cr-, �w• w c 5' Cr.
= �A �r� 'ny~bbr~eO � + ».� bcn � nan n .wn rp0a"rdo n � p� nro -, , *-.CD CD . e. cn ►+
" 4� , ; 0 co co0, 30O o _„ c o ,eOS � c,N co w3c3 °c.`b° o3.�C� �`'
ago c3•or�eri'or"ey �Mwo ° a-o,wc-wo o _ no0�'�'3' yo ..00• �no 91 re ..wowonvo axe r 1p
[nw S;n. �, ., 0'...cn re. w ...rn ren NH n cyR ...ro ..00 ►n7pti reti cur-co .w. . O.rt7 nO ►']