Langlais, Albena rorm VS. 61.
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
wir 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.sd 47/ R ered No 7 7
Town ' '
County 1 .4.,lelf.,A-•-- Village7 r 4z^
or City (If city, give street address)
Name of deceased �'�.�e,r.
Single, married, w o�r•ed, •
Sex - '.Color' or divorced (write word) * Date o Death...��� 4 ode
Age....I Ye .'4lonths .Days 3irthplace ...21:..
Cause of Death C G'� G c� 2(irC 4.e, • !' —7....
Certificate was signed by IV
M.D.
Address
Place of Burial or Removal) - G4'-.,i .
(If body is to be ors ' %��
I , fi in space later) ,� �/
Cemetery..., ....! _. ... Date of Burial 19. 0
(If body is to be temporarily eld, 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 ac ted the sa a for registration, have recorded it in my Local Record with the above stated Registered Number,
and a basis t r�e9f I REBY GRANT A PERMIT
" ' ' .
to �.
'me) (Address)
the to hold temporari y the body.
MinAtryker or pstottn haying charge of c9r7p.) In move, or oth ise ispose of [state how])
Dated... .. - L(i 19 s (Signed ... .. .. ... ....
Local egistrar
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 reguiationa), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
a4cr0 •+ 0.0 -, 0o•wc »•o--+ u, 00 5•a,^ bb -el bbNt) "'b4 -to4f .-.� o ( ..'- o'C V)� '
•o ?r N ,
•e ti n n o ,`�."n -, e; = .1 O O n '� n 7Seo O S 0 n Sti n n C O •-t + ��
4.1 , Z.< . n p'Gnn. "t.< ^, •a0 ^ y.�•N w ` w y ^I prO n 't ] .:7 G O 7' "PI �'"V 7 R7 p
t.D7 -yOay OSti N .N.•ni �-'• Myy � C•w•.A .1 O'S•'O S O ^'.5'elQ epo . O -,<.. y 9 ••, O 4 an, o w O S 3 `, v°i 5)a S01g r0
nba+ a- w-tnaa'n bN o `°'�, w `° 03o n 7.o c:N .:A < a:a.ee0.N `°' as' w $ p
,Z^ r, n O•-w °.9 W-r 0-" 3 G.w op G a_ o n W n O N ?ro C p±(Ti < p to °. .
-
aaNNa 3oa c �y
• r-rn ' o• ^ g Sw N w -I'< w rgl .w, ^' <'NO geD O Cr. O S....,V n a w C'0 co r,, p' ti g.- 0 ~d.zi V 0. 0<a 0 C
Ate so x'o 7.0 n ...c wp p.0`G O .. tOm0 � ...r, „ ro w 0 •y •con. ,� ��O C
. ':7 wn c nrt ,...0 <,p0 ' y .'`< .,, On a'7' ^"""0,.,S ,- nco .s ,yNb0 "'.p..non ^ V�p : `.
117 . 7- r n a0-
04 S w , S,.f9 n G ti b 7
H=X^ �'::Gw p) O 1„b S as N t-,cr ^b ^ G D w Ob N O p o re , 0-?w N N N -° o R.- ......
' "�^y r, S< .. ^� wH'oayw » c �� n, °•d��< oa �mod°n, ns ? " o ::^n `�° ^.nooa+ w �.� b p�p �oo U
too-rs.0 w 4•N ClO •t a.6 Nan ,- w37 ?..0 A ,�W a OIt::8 s.SP' a.el') 4.•y.»T S"^N,P� a, n x .EJ,A � 7' �[l
$ z�•iu ,...5 n ., o•o B.O b o a y p G S k, ,.� w
n "+ 'n .y. (f�' 3 < tut, u, nQp,.,w Oo7N o ^; • < oerv •- av70'N � .w ^ w '.ti
vs ..7 oe, `w-'oo .-..o 50 , 3 •, to or. orn f'' '^,e0Z' 0 3-0F.PDF..w'a2n o ocfeo < CD3 - •• - IN >5. rtil irf
r 3 M -�:3 ., w n G.»'N 0'5'p„a^ a.n a.CO p CD.•n b At n N `e N.... . a °'•S"m �.ti 5'.., ^ < '
a.oa .T •, ON N o •yn � *Coo p � no want^Tw oy Ao �Ag L
Z7A a''.w so ', n O� N.,y n w H w`< a•§ ? S .y w R ?n O io `t a.Gb 03.rn`< -, < C ►..�.
y 2'ore es o'p- .o..., n y Z0en p•n o c c.�-•0 o'c 3 ,r , -00 0, w 'o 0 0 u tow -.cr ::g :!
01._.7'a0O w sO �� ,) � 0 rLli1
--t C 3 N n 5 7 A, p O 5 m C H A" Noa "Oz-2..T3. Aga' o,o ° �, d.V r..A ° w ° =3 V, n a O .-• r9 O Q 0 a ^ ry O -1 o m z u, n ' - V
• � 3 o) 3 0 o n a w -, rn cen w < 9.:c-, c Po - n 2 Ci
ZHsn - now N 3 w -0.�` ..-� a7.) Al FC cn SfltIli
ar.9 •. g(y`,.n < a g' 2.,! n g y a-"^►'� H�'.
O r•..t ', pp n y p, " »b 0 r "1 n '3•s `•� :I N w w C p 't n < (p N _a'a n. w_ W,w..O ill
0 w n w -ab D 9 p 0 •, 0 .7 O n O n 0"-0.N .< ', »,vt w Oa'n a' a-0.p 'rt..LL. y n O.n .- C 7 pr'3'», w •� 3 7 » '� '� .+ ,p� n n n A' '' G O"� '� `'' ?'b p ADSLJh"r'i1a o ^. o n o fD w o c" o x .�5 �° w t"7� w �`� - o o o c a z...n 4p9ym do N' stag c �',..,„ n .o a.9 ...5 . 7 T o ,H n a n 0' b tip o,V,, H n a-^. Ct'Z „ wn aa< oa f 0.su^ n, Kk 000. o � Sti �� `° �n+ n - so t=N �fD CD _ r�ee wO , rt, n n < w N O W e9 ..n w M.^.N .''..M0a W7nm�
�0.• " trbedS�.0tnewireA ebo3 '„o o-� < < ��' ° ko'< 3 '0 tvn .^»oa : ^ F,'LIm < .e.n, t H al,,,r �ZC
-tnn NS b � Q:3ti n5 ww oqn e.° Sa � a... .-, s: ecnN ?� :�G7En9n -w � ° �v•0nia3• �°° � J O � Qp ' �ae�u �• .fD �Nra7'° c �� oy� �y r. •e ' trf o, NgX7
p ,, Zy oo p ^ er G.+'� 0 3~R [Nen °:[S5 � fD3 m'f 0'03 `D w v o T �, o C o G A �, A'nego ''? wAQ. p.^Og- £ -w""c.`ak61AMv p ° '^ R� 2i• <4 �v .»n i , v , 9 °=- n " � "�ca .baGn � .. VC` H7
�.ty • �� `< u" e.r° et -, M o w o r•< -ti `.E' .-•5'C'3 oQ;, ..c n = n"A 6-'< Q. --,i c.. (P'd .c 1-1WZ7V)i' �� =+•,, ° •wa a0 9 ° a -" n 7+ n < - -t » °p, o N a N �2^�1 N .ws n o G N 70 y o'. e.D ab .•.,n ww0e O.n -ws `":a• n .+ Ew c~i0 oct < �...nre .y•., =tea ti 0a I0 t" wGf2QEPi - ^t .'°,po ^ isa '' a. p...G. 5n Ga v. r nw07'..aO -t ,.. 0E-BOGan�< y ,pn' ii�cno � yw ^yhapG »a�' n ^� p � e� mn-700'0 °''-. n <n gxo ' C ,05"0p..r•.Tn nnwO .°•nNSw .lcT 7O 9" p n n ary9 '' .-n� '0 .y n y ?"/' wOq n `'.0 "^ "^� E rD.ya.�. k0 a �,ti w'�• n c e eP n n ...b o Nw.a-0.•••y O 0 yy o �-o a .� .^f 9 p N 0•ro n `.y,0 '-w �.E ^�'e. �i'.
A 7o a w 7 7.- •0,o m a'a n, N_ C A o R• r au)b o ,;w ee o p°, 'G rb �7 ,may w CAS. M sue.° o pow Q7
.4ry . -JaV; w n3 -n, 3 �••`"° oo -et on •o `°�o -,..oa0., c: w - nzct.2 1a-;n ' n to
g * :;, - c,„ 8Ato8*'$ 3 a .,.9 , a° n, o4oav °� 7,w -5.(0 Pi0-- n0pu)... Cteat9a9 � v- .6 `o Q
•, 3 rfir C�f' N'0' ro �7 '� N S a-t S•
w ,�,^^», w .'., O <O y <O a t :(, Rf
kw..... ...., .'. ^I ti S.°n(A , (S0. m of.m fSe CD w ,c> ..� p to 0 .°i,CSo `�i' �JS `i .On 0.0 "I �.N y a a.,:-.vs .0..�•b G.coo o ; W
c n H�