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Godette, Edward Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT U' 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 RABLE BLACK INK. Regist No. Dist. No T ty Village. • "✓..�'� 1-- :.. f' (If city,give street address) Name of decease. Single, married, wido , Sex. .t.. Color,., .. or divorced (writ th word Date of D t 10 Age Ye Months pays irthplace. /Ar Cause of Death Certificate was signed by.... M.D. Address of Place of Burial a . Removal) .. ` (If body is to be ,T.I ri s ce later) t _ ,G(� Cy' Cemetery. I ...1.... . . . .. .. .. Date of Burial. ... ... .1 19 i (If body is o be t ++porarily held 11 in space later) The Certificate of Death ontaining the above stated particulars, having been pres ted 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 ecord with the above stated Registered Nu j�an�l on't sis f rm H BY GRANT A PERMIT 4e€ 'j� �7►'r•••1! v (Name) (Address) the to hold tempor ril and.../7 the body. (II+• v r +r Ile,:.a ha�ng�cJ rge o co ) nter,rem ve,o erwise dis [eta howl) Dated.... .41071 w .... . 5 719..k..V (Signed) .... .. . .... , .. Local Registrar This if- ..'t is sufficient for the Removal (and Interment or Cremation) 'a b 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. mil' "a pewtn A og"owo °gA ryo3xro mwn < A °r 5. 5• OP-tom •..��' , a.'� t� re .n„• -..s.n .9- ... ro w A [e O . ..-0 n - 6 C1 {� e ',j'K tniM 'y � �,c� nE � �e r:-°cw �'w �,tr'»;° n w �aga �icu '^ oo ��' �er 'tip a �ljw ag R p. ...i ., ,ny n g•a Sr"S3A 5'giin reA � o m•NB vonn ° tfl l'"' wow ° °-0im ta 04nnro , n ,Y. O•w're ° to0naCOD "�X II oP+ � �roG. o•2• . ,r;o•wn ° o''*rog owti1"2 ,9to ,nrww.. -'O� S."P'mow �oa . °w. f��! na Fn!� 51P'�.,. 000wn :, ° 8'Clwea E.. Q iC g.l na '4*0�*t.+, � w ?, . ° `an'. M f' �Nry+ ° wa `<° gOa � °* ryt44 °�r°fts• la' - `y'� v g .4 ..° C3i.°a, 5° t: 1 fe '.., w "5 55 ° *w o°,rn ,."s w.° .at to y O , 4 w O cr irp a'nn re :089r nroa° • *Vogl=veo, 5, 5.5'1'a?:<° o � o,� r°,s„.., 0sfir ure "�.O�sCi7 ,�+:x. �� �A �� s w n ' .. «...+, p.CiCA�, III_L° Ae1�iiitifIiitIi zr% � � OA °' «.....r'�� '' �,�°C �. �" n^ �Ka d. i E q0 p'< 5 N r 5 °1 g M w":.°rra w o G e) .. DeC fi-,A g x. ©,,,° °' '� "p o y re . o w .5 n c. ° '° w��'•0.LA 0 b .., Cl rn e ..1lg ."'C 'I 1, Ce C`4 a z 9, ..*0 .51 = o'y =s''-1^ ^ o.' A,4 R� < n p C v, 0 or x Q v °p. ' .. `��w � ° "g ...4, ' e.O2. ro co 5. 0 o..n' p,v CS'te u' ar;� 3.Q w gr. � . g .,s...e,', ®w,�w » opo r:�*P5rg.g'g nn°•q & N2° Faw°•o'� o �a'� li la'o, : ts0ufgg. y g, wr, t' ri N't n y - '. ..n �". r w tp'O .•. G".'ro fk 2.5. o ;1 s �rr y°«.. � �.'p O - ° g� rn 5•N e y m »,�� tp �'�'», se ,n'�S' '" n'B. K ""� '"� n.s �' '�.e1,�} t x o.,w� "J n G•vr +pro;-1' S go m .n..w M"` ro o f 2 R2 0 g u, re'd p.^ -°, 3 '�»' El c' w] X F] „� .'nW *1 0 rd'" 1 �• aro °30q A.Q'n n,b w•o ... •A• o'`� a.a , ro rn - » 1014 "� n. o c ".sly t°3" fe w K w'y a .. E...." ti 5•p C Filr .1 S . 'y�n •J ,e..{}�� �'# ¢A.�¢pt .n •�re tp p'w re�w .°•' p-'....`tom G A A �.� py A- - '� o _..�., P&I. I °'4„ A b�•F' .1 O ..,.0 gq .R E•° A. 0 w 8 ° `.•t5n` .'g- w .='w R =irr'-s.~' ':j Q'Q' s` " a 0. !j'}'�•ge en , (fnp�n O 0 '4`�05q n .°•, (.pn rod,.A. 0 .�w,. g fe y E,5 W S n c. e,,. .w+=e > 2 .71 ;O h G w-y Q,,'i,.^g.fw 2-F.i„ re °, 3 ...'.n ry ry w c, 'o "".6-. 0 0,�0 .-; -, eb o la....tyro t, "'0. wf as "NR O* ngw. ice fie . F' et w .. ;. r.n Aaq ru ary A' O g '0 .�,' �s'A �. aw 0.,-.3 ogoXC0 �fe eta � ?=5•coao 'n•octtt, n•otco �L .p " b* __ 17 ncr .o ..^ rn ...5o,o b,a.so garo < �ro4 »,zw '1 :o''''0 ,'P' a r . .. A IF, C3'� N.�w .Y ° wn •s � cyo�t�e wn7 � �+ �� nw"o an �°.,._�M ° �y_1,,,� �i' ie..e gr - . 6;,: w '8 o"Sg61 � E.° a `PAP, eto ; »•a.4_g•e'r, Q "'l $ A ....� d • -,o0w ' G . 0. „awn ,•:0 � M „ .i us ~ pop tAC2i' Sn t �e ree jR2o © ... ,g-••*na cr$ goo°5. p,,- •7, 4-4::"a�-a.raf° rit ..i M F4 �xz MS «' FFoyyii ° "°+^ wo .°,''� nfao•].».°o _$r oo o � o � ° � n � po .SroaeC) ° �g''Pg+ "IZ vi it Q 4 e:fr ►w.n ps O us,1-5,.n „' 0 ""1' .wy ,.0 w O me ,wn ,,- 4 ry ar. igiiiQIIII 0. ! I[li!FV4llI} 20 1•4 • pL !LiOa _ onyr'IooS•z.G•ob " . Cw i1.4 PI ,q1 O •,„g 6. v1 +� �t} .t" n ' t*s. P+ m c :+ �A� �.... w�0 •*.n y 0 by "d v" t0 A�p M it 5* %to ' '*e~A.<. a Fa g A. .nj Q.,5.,'q n, m .°.':O K gt ram. �" Q :�'t+7°.,. 5't • . a V E M'o 5 .::4 t r°°e S SA �e"o S:1 o*— 4 m 9-° C.°° *T� � A "• �� "s7