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Bennett, Estella Form VS. 61. NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) _PERMIT NW"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, LEGI/BLY WRITTEN 7 ,IN DURABLE BLACK INK. Dist. No.Gi;:.' Registered No... CountyTown _. ..c ... .... _._`. .� t. . _. . _ (If city, give street ad Name of deceased „ G.... C. ., Single, married, widowed, Sex.L r1'lkl Color s�..or divorced (write the word).. .. .. . Date each... .. • .2 G 19........ Age Yea a Months ..1.2. Da s Birthplace _.:.. _ ...... g P 'eAled/rfli' • • Cause of Death ....... _ P..� ..... M.D --- C�t�Citdle WaS-<sxgned by` w _ _..._._..._..__. w. Address • Place of B rial (or Removal) .. . _ ge .,�e,. ,, , r (If body is to a ran he , i in space lat ec Cemetery.... .. .� �� ',�. Date of urial . 2 d _19.. (If body is to be temporarily held, fill in space later) The Certi cate of Death containing the above stated particular , having been pres ted to me, after careful examin - 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, an•, .,� the basis th f I HEREBY -/TAP r I '/�� to..t' .L. .....A . .... ` i�/, �.r...... ��r'•�.-\�.1%li� '{�� .. �i% rSa .y ..• .. ( e) . ) the �. .. to hold temporarily d C: .. ........_....... ... the ody. ndertaker ee..pret .. terig-et ) (Inter, r seee—Mrw}) Dated... ..GL �. �i 19. . .. .. (Signed) i._. Local Registrar MilPermit is sufficient for the Rem val (and Interment or Cremation) of a ody 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. Li - f.., .pz.O.. .rn.c-.r y•t..-3 Nr � c.3,»$ `�P ''; �' j -TDI cT ti 54 o , 00abQ ~ _4� acoawc O• • 041 0. + ril m.. fi 0iOOm f,.N �' O4 O « Tpa.c " O *A ,e a: w � � r, x A = craAc o' m *a-.�pIDD % t. 'ti ▪ eb, soso tf Z, 7z : n o ''n .- m , o O go Q P = r-w .fo <. '°Oc , ' -- - Da P w< m ° n K. N Wp'f, aO - ° " r' O ma _ © aO c • br-n -I "t ... ryays"nory-' ▪ �tR �a `<OQnanP,. Q < !y " a_-, rny . " pa < v. -nA a , dE!I Oryn c"5. N`" A A.) O "ry K a,'c O a. a_ 'rn a cr v — •'ia-'a es, <a , -I r 0 ^ ro 3-. oR ru' O ,,.., 4 NpN „ F, .n .n' r A' S-,n.ra O �. rw ro wo ." nan " -, 5 nA m ?aoOR•m'-t . „ -.4 ,-,.. yR Ooon N ty n ro . aw p QZE' rn DA w aa- R �. w O ~ roW ~ ac 0Q.ora < ro1-' z`x. o N. ,- ob . p p0' - -.wo •nrttiy O "" A< pereH -. Gro - 0 ' r �ro wron �mP?rc ro �. CAow vo n . nb 5zrnre ' aa, a ,, O a aif `W 'o rv0 wnB 'o " O• ptY0 p,-G � n o p p, tc 0,d Y,...,� o .-, O iO n w 2 co�4C r nC r z a 0 .•. , - nOWazNN ".o "-..° ,''w < o m Z�; ' ny '• ' o o go a �•5 o »o ' o 5 a•+" ow,o Q-o d •-) • er' • ri ft'-Xo a o . o " o'hN arxe Nw n = N . 1•h C Y 1 .n. 7 • Ien . trio-is TFhN R. co