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Drolette, Harvey Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT Lir 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.. Dist. Nit.°('County 4--'__) llage - (If ci t a ress) Name of deceased . Single married widowed /07 Sex Color 7, e th or rd r divorced (wje iirl) ' ' '' Dat,1611111!P' /V.,:::;,...w.1407 ,.... .... ...- Age......._Ai...Years 7 month.. 4 s irth la - '''' '. Cause of Death Certificate was signed by C M.D. Address Place of Bur' (or Removal) (If body is to h In 7,,:dgg) Cemetery - . Date of Burial liI P 19.1, (If bodly is to be temporarily ,All in spacelater) T 1 'The Certificate of containing the ab ye 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 Nwily4S01,...nd_on _the basis f BY GFtANT A PERMIT to—, W.nef.r.•• '. ' (Address the to hold tempo . d the body. (Undertaker or pe p yaving charg*apse) (Inter, se spoor of[state hosv]L _ Dated fi " 19 (Signed) Local Registrar This Permit ' 'sufficient for the Removal (and Interment or Cremati ze of a bod,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. 3 &' 0.• :ren' < O 5.5:8"5E � 21Ar gsg Ill (si» » n g•0na eao »tr nr� a;_ R . + . r E4Ku ,' °° ao 1IUILt 0-,. iea< •`o-� � 2mr „ O' ro ».gtL W start , -tg- asg + *. f.w W a3.4 ..S o nna w ...O o n " o,e „, t • — ��... ec05c5 �S ` � .C• ae auoen �g' < m o _.ua43 : ; 8n *ft. a.V :F4 g .. awp. o . p r '=ac'gl.o��o` . , a y s.4, np n � .1. i S� � a C)yD + w g w o t* w " '.w 9 n }u a=° w "g-g °o .a . a. i Ili i 5 cr it Li° �'i n iiq yC� " A. `� n' $P=,o w ty ii_ 1i!j ." :� . g % ewaR,w E,o re.3131 '''o !t*1 y 0 €. rr��SW-V„n .* .t ;+� ''r`'f° '„�� Flier. CiA s. 't LY"�.#'1 �.g +,p.P, ff ....e o' 'y "'i yt 'A '` .. �SQy ,I2. . ^t'f, �y` ..t"'{"...,�,,. C ': i rt w ; '*.. 4�,,trp..O �rogl c)`�+ ca' .R 9.f 6 fC° '-i ( ' M: 1-1i l>Z y `s ems. 0--, -0# �a `.:. � ..,5 N O N 2 ..'T 6 5',•n g li g' n O .1 y..� >A a C ti•-q 1}9. W R._. o "ice.. , Y Y,: �*pl-':I v C 0 m''' "mn_"°i 0.►9i. N s ee' Q•"� • UTir 4' �$P .:, _.'• o 1M nro .1. ' o 6gq' oti., .-.,d _mow.,o pa `sQa0'cw �+` Ea i fi; $: k"Z "a:.. Oei a',4,,,i'l r-..,1.., - :4-4', _ rj.N: y fo ,..«y is CJ'w �*6. „�j ag'�p ! c. �". +r. 1. xi ., ,may? p o ..._.0.L a .Fe o g .^, 5..-1 A 2 e"�, '. -0 0 0'd w .°, n q ``:.'.0,�'-'-�- ° £ i _ �. PC $ yam a: 0.,4 . ``P" ` ` g. ,co -,2 b 5.11+11) a0 .a ?; 0c Js » v MI .. o ;. Nvit • * ...Q.... w tee g.o. 1JUfi r co fe,ta o c, O ,Y A o• ..t*1'�'P.�CY �'� K "x 5' Qs CnwNo o_4' w0 ,,,oti. 2 E: ,n : 5H na i,Q °Ha 4�`e .. .S}&' �_ o m pw���.00nyw �*cd �,no xg w �.� �, ,�q H►y is ...► -m _a�nshay -•40,n`2. � t'' --1=•,g:t .*gC :-B1-1,.. t� t-2ernC ..., aC � ge1f -:- - Qn �.. :s m m E•O BB.`' " R. !'(e Ds .an~ ,w..-Ii UR nr "5: M •"� ° e A ""Z O a n ro © ia. ° • $'n oww �� rv ` o'ry G �,' 05' O � s"9� .. -, itzr r2g °I 531- ° r'.4 -6 °"�' "`°.c er m n 5 G'o ›,a fp ' 'o�°, y o 0 0-....a- 0 r� �+ �a 1.w if„ 2„ a4 xs• Mt .. o to -� Aa....; w0+•no zit, .z o� m `3 ia.0 �e m-, g.a e t{ ` "c: - m a o�o.�� y°^.o °4;: CJ�.-.4. - 0 p.m . ® e. a 5' e °� ''4 =n °p5' `<•oit-.�*' • o .5'w4wtx' ».'� `°oe�3wm