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Joslyn, Agnes Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT tdr 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. Registered No_._.2 37 56©1 -Warren Town Dist. No County Village.G..i.exxs...F.0.1.1..s...Hs2Spi.tal or City (If city,give street address) Name of deceased Agne 4 DI, j.p.g.,y, „ Female ^rhi to Single, married, widowed, Sex Color or divorced (write the word) marri edd Date of Death Dec 10,,..1,939 Age 59 Years 1 Months. 11 Days Birthplace..ge..r Ri v Or.1.1.1g,,,L a.Ac ,.N; Cause of Deathill.Abe: .O.s...S D,. .tl .§-1,1 ? Q.wn,,cgl;,v.;c. . cellul1O.s—unkno yin;Diabetic Corm `C-erti lime--was-signed by- mcs rr 1.P MAS l on , - . M.D. AddressQl..q4s Fang,. N•....YR Place of Burial (or Removal) vie.s.t...Ga„AK1 ..F.4.1.,.a,...N'...Y.e (If body is to be temporarily held,fill in■ ace later) Cemetery. `.. e..........a.I e..... ..... .......... .('+ o.ry Date of Burial Pee+ 12 s 19 39 (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 exami- nation, 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 on the basis thereof I HEREBY GRANT A PERMIT to $etiv4r4...Lt...P.Q.t.t.Qx' -1 ens....F.A1-1s.,... T,,...Y., (Name) (Address) the Uncle.rt.a.k.:r to hold tempor • ter the body. (Undertaker or person having charge. of corpse) me ye,or o epos',of[state how]) t Dated.............Q .......2.s 19 9 (Signed). Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a_body to any part of the State (subject to local cemetery or other regulations),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required. " pqp�0 {� n '', r°w p r°w.°�•r' y�' r n•ws p t . 4§t . * ft ' .A*..y pa ~ O. RC•SA G+ i'•�5.7" .pprj d00 •S�~C1+•1 M ¢ ..r"' "+ _ *!Ci.�7' •. 't' tr ' 9p C' W' `°• W oQ'. S.e•m e� a' w,-1 a 0�b ""it.,,..,w'n"-`2 1 g 0 : Kam. ..4 .-4: ,, .!; • go lo ••�„} ,$ 3„,.. ,i0 i3.a nA .r gu aR ,e, O •.w,.a Og4° ,, • �, .. t 9 k 7 f e � I S=00r0 �_ to i•�t= a 0, g..' s . ,� .' w y pp• a• � � : jt r w� i !° ar tC "ig tp� C� d :•• ,,.µ" OA y 'sniAC _ { i.., . o ^ s � so o �7Nti R A A p • . X g S01441"" lgR'.i wffip:glyst g a 1iihHliuii EA j[R=I 0 �' a• I1IitI3 till /h ^ ` • B N g ; IllJt1!t IiIili1llId1U1 y 1 `'nR7 i t' F A r .. ,y y O'AOz. " A0ngg.s.y.• ;a "+ .1g g „•,,T04':^:'ti ., 5.p.5; jEtir!iir• ° ECpQ4gc w$ �•`o ° u•R' {�*Caui swo '+ spy a • w ^ •w p� i 8-' `a' rya.9.9' iq ;ItI �°+ rocs /. + o i 0 .$'50 r+ .,sue Q�