Stewart, William Vertu Vs.M. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
s? This Permit can be signed only by tha Local Registrar (Deputy or aubregiatrar) 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...._......._......._.
,[ ���wI Town O o /
Dist. N� M punt}�tl./�!/IL. . r Vill et-,0- •IR�'—Ir
i /� 41 [1t city,give street address)
Name of decease
�gle, rried, widowed, '/
S Color. . . .. . r divorced (write the word 'C'�`� Date of D L 1 ,9�/. ...
Ag�rr3 YearsS3 t Months./7 Days Birthplace
Cause of Death. eta,
Certificate was si •. ..). rCa. . `I.D.
Address.. ... C.Ar tit
Place of Burial (or Removal) - ,t` �. .
Of body 1s to mporarlly held. el 1 Dace er) y / ,
Cemete J flctN+ Date of Buri .�! 19.
(If body Is to be tempered! d. ell In space later)
The Certificate of D 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
Nt ran er, and on the seregjj HEREBY GRANT A PERM!
ame) Address)
the.aattr to hold temporarily and ,,1t the body.
(C taker or person b og charge� of corpse) m ,or otherwise dispose of Istate bow])
1'7�' . (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.
o,.4/ 91 Ft 'VA ,45 o"o'U 2. ^E$ °:°,°,ET rig ht TR %° '-. n .1.R gg5:3 .3E OSMm 3'^oy 0
ns+ + S � � a _R Tan°°ve��^w..5•>•2�oz .�o� ; n 3w'=Oo�,a3 ^ neYg .'. -c .c .' n n°a a M
-Z'"• 9 urS'<RaN'gwa7c - -�y rro _.- n n 1n .,n . n �'Ygu°'," n op'p ^...o e.^w V'o mzS i'^pn . Z
x,. . eT=fit Anors, .., ::2-t E. gS^S51�A.^..car in� C ^A . ^O ti^ _Fr a.-4 E z R .v O
%.'^^rff. mE w -.wy^ N+G :..• n s,a.a_!o ?... ro = o -.Rn"oY , . 00 oGLm 'aa... :. O
..-I' k n 1'0 0 ,...PS ;Y wain . " to ..N: oSo 5..,,<° E nc= -.S'n" c" >•• M P$.C�� tPO
o
K 2R3 :"' 5." ^ " n77o.. •S' svw C.." < o o.a - On < Y� V, V1
i o'^Is- - a 3 "yro36 < og nnss_ P3L^" to ^ 3� �R �x ',iv, 't1M
7 aZ nw3.n.Yv.n PE ; ^3 se
O. .o^4 °^' oc..•.A ^ nw a =°--,3^ a,c3z gory"rr �.�
IUILRIitiIHtIiL
..-. ^^ . tI111titI
tHUhIIIt1i4U
_ 5C•arTIM
Y ..O2. 0 . __.n 69 ^ a.t'C 'u oo "'1 o ! EI
P-. Y >• !/i-Er ' ^w.4O v n 0.1,
p4 to o °° n; g°,^'R ° P 44" n=1 6.,n, ^^Y Sn o+ ny., owr �1 P.•" mo + l i; M
A a e'^ ^ gal 5'^ En u_. ^ ^3�3cw '4� ei4^ n ^o < " o ,. - Ofn
o =R.^1 nP' ogo �O0 g, w." Yo SS4�..oglw5'n ° NQ °,aRnS=i ne'&o ^ -n'8 .1 y qy" a r DZM
w mp7aC Nw- o Pw 5•ox n o E.ac do -. R °, � - -,—E.°, yo0cc' 3GIs -:..4.'o 3 nt..1
^ +1,i�n qn ^a- o7 $ "- $an+'6 �?c ' goy 6'R -a " T7� aa.aR $,^ nsB E ��3nn° v' =l ?.•n: OMO
$ P{sfw2 "a <gge'V ^SnK La.b = < w"L 5•-^j� w'<ECW �a.E' c- g' ¢:► < "im . ! o Z-Z
Si 4-1 :. sl.E.1 a33o a° o o^ o °, 0ir-, ^Por u ;, R N,nnv ' ^,� c Z-.'"o ' tiA
V09. E -,' ° -- -ni ,'' f6g an n'<d^a 3•^ ^ Gc' ^Zi w L �"^ga S$ - ^ aa.2 2.6T^, yr 12r-.yo 3, 7 - >z^1-1^ =:Fi ^PV' ;a.M ^ O, qq �TS1S- nµn E�{^J pn ry
C m D A y a4, ^a c n n 3 Y 6 n g E V 3 5 n R . ?0 i -'-- ^ 5,A 1 P L . n n m,e w c - M Z.D
Z Z.. s' `S" S ri' F. x c°,4 c.'< co $ ^ R % E o ^ ^ o ^-.^ 4a.o ;I; 53,.o -0i� [ ,n, m°;10 - ^1M
ay P nPwoY�n ^ n uo c�,36_'•-•- Za < n,�_ 4 ^ar^ r�3`�s..,P gem oA - grim
° Mane
"I 3 Cr nR 3'n ^^HNn ��'^R¢¢ " n n &9RPC , _.^ _.. ra^^ _n .:9.^, c S;.D..1 G'i°^. �p DEN
.t ^ir“ n -•�.9-tag^ ="3.3� ^.y o^E$ R ga E.wi 'vY3.RR9Ecnyy3^ oaE.'o.Q a o . - 030
o'z0'e i9, -ri0SR'�wn ^ on ' w o _WA° 3.3.^ ^ 3'Ro°Rn*^' cam=X 'P'Rkn —1 0 3 • _ MMZ
F`GOi ` .,Si •,nno --,, ..OP o-.a� ' N0000 'x c� �^ ^n .n, b ".T4�` � ° a„a=fj a£nr'To ...1Z
EF-••• w_3o .. SR " -.wo + u'$ E ^ QS ao a-' i.'^ o v you •Y " = E wo °=°'°4% s" 0 xi-% , U1
a.GNo E'.S g'-- c doouT.. 'Q:S+,. � Ga R0°,R d°��'cca '^a� ' y.. c0.74 _no, On
crz 3Ra-3k34 TN TR °,?�`< y^R • -.. °ocz_''^ on Si,"<n° 0 '-' 2T° � 'AD
3,n o u _ ' a- _. — C 6_ z n
n03 E''"c.'< r" -S5,�•i, 23G " n °^,L' u$•q.c o: '^ <•.3 ' cc �^ co n.o 3 cR w, crer., 74oAa0girZ.Wgivag m30 . �D O
np s-^ ...41c. SPn1 u od - Ear ^ a.;-, n cN s_o .. ^ ^
!im°, o'n_d' ii c,4 .'. 3,'.'P.< R R :."^ ,:tRE' a' .'R aL'.08.5ta ? s,9 °.R3 'aR'r. � •. 3 'r1