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Briere, Leo orm vs.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT lar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Pr ma 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_82 Dist. No 5601 County Warren Village Glens Falls Hospital or City (If city,give street address) Name of deceased 1190. .tt,t...DrieX:Q Single, married, widowed, Sex...11 41.9 Color.Ilra Q...or divorced (write the word) $ill@ Date of Death 00 .Ln,....3. 19..., 9 Age 16 Years 2 Months. 6 Days Birthplace.Micia. tUX ,...3t.t.a Cause of Death..F..m.Q. r1IX d...8. 41. 1-2 .. .'e.R': '.:aetu ea lef.t .Q.Q119,r....t2110 Certificate was signed by Dr.. Mal ..a,111,..C.*...Ontiabart M.D. Address # ? S s.Q. .. '. Ol.P.s...11,r...Xa Place of Burial (or Removal) T(J>lan..sat...Q11a.enabury.i..DL....Y.• (If body is to be temporarily held,fill in space later) Cemetery St.r...Al.L 422r tAS...Qctine ery • Date of Burial Q9 wr...254, 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 Q.X'Q .. .. Sinel.e.ton Glom. .F.a11 ..1T.e...Is the UndertakeTame) (Address) to hold temporar - , -.bs - the body. (Undertaker or person having charge of corpse) / i!e! ,, v ove, . ), , dispose of[state how]) Dated 00 i , 23., 19..39.. (Signed .. ... ..ie. 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. �'yy °'= EFE' w O41a+ ooli �-,g� aneoq t9ho4 0�-"��p a^^ ,a �a� tZ '� .. <� 6i a �C E. A,�+'.�s'CJ'i��,03 .�2 �s n w a-o ', pee p• z o liv es 7:ZC it °w'~ Deb tg i 1 n+,`0 0'5o^ 5.o 14- ' g g+ •v ^ •t5'rt�i`� o w No 4 0 0. o.,, t7 .6 1p 1g 5on ^ o�...^ ^ .o• a0 ^ 6-^ ,r2' ^_ r,. (54ki8A, .'nos'0.2 ;1 ...i ' O 9. � �.w`�•�' o n w "'�,'i S" n r k a °R'�'•�..• e � � 0 w ^ M � .�o N. • v. 0.0 p ry }^8�� Q ^ "y1 o `ti *pro dnvcs 5. O•w^'p ;"..,0 n o •-.27"K - y 7.°0A00 Porn st • M N ..r.-pV r .. z w �I �P"Et, R g Pi :4 Qg ,- R. ,,. `i w q w 6�. 6 (p 3 0. w li[ i nea.E. a..$ a a 5° ,. o yE 4 to '"..nC'.. �i�f ,Y.+. p O w ^ n n • A� G y � •nJ° 8 e. ',� .O."z ,Oy fe . : �i ;i1. 55.2-O•n. P W M W ei e n g C w p s' 1 '�1 @ O ��`��} �y tr o {f (off• gyp _.c(.�.,Q•�, o, c? ^ �J � s /�C� Q�� 7y �y 4 �QyeTf! .Q•A pp1W P� (�1 .T" wMr�•O �Pft l� /�i. FV�W OJ..41.O. inrqiw •ni. iPg' - W1 G. .^�. r n [� 0 .1 11, .AO.i ! '-.1yip ''� �C 0 ^ . �.' ogn5 ^ � ' � ^ fir �p• �,o $o � "'� 1 � '�' �0 1-" w"0 " l� 14me, 2 -w .n^ 'go;n '."n •Oi -.O..iyoWOtniri �'. .a O�� �• -go if.epj R.3 n'C .. A •",0 'g "'.C p,:y Pr - o f p ! 8. ..'• B �i A 42 ei • :A • 0.1 3 o ;g- a prop F•n0 z r.," i< �C . .,: i° O ..mot J�.: Q0`!'•03, 1 G•G~ T� 4""w o '.�� x� © I. pP+ e_ n' _.^ e'a4 no ...S. OEw. Kg'_ N =gRa3n 7• 4w> A p • N�O. a O .�i.;:olat,7—, + as O n Jf"'n • ..f O i�f'g �' n w r s! ii ; si. tsi Zoo ots mi t!elf ,-... I "a en "lo � Mw W yR $ * 1.`' iy � � ^ noae•�' 'r�• o � C. ,� u�SO 9.«~ xonv "" �+ ea'�` c ° 5• '9 -^,'1 goy* � na ...cr.g" •"+ � a �, x "a viz aq ^ . w Ee'�s! ,g n .n ^ 5y �enao.e " =+'6' rw C.6 a•g 8_ n b ay ^ m 9 �x. q Ra. n e ^ S ^ 0 w b ^ � .wS „TM � [ . �(iiljj �u ii O R! WO nm .Oi.` , � A M 0' ,QQ5wE.° d'-.= wr. g•�J p I4 'HII r, C• ibi 0 ! tt c ttl` �x�w c • e q P wl ..l ip iii1k., i 54,4 O �•V° w p ,ate n n O g 3 t"i O -.zr•O4,120 w n p`! • Cyw� M 99QQ7 '�"�,•¢+•. n ,.' DDQ �� t� �s•p��eJ. � �^ v.. x2.p^b,li{� aOfx.p�.� '.� M ;(� �_ . A".2„ O K iit a., .....�^ C`Jy' �! n .. O 2.p`W Q Pf C'.w�, O ��p ,� i�••