Harris, Alice Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
re" 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.
-- Town
Dist. N . T.Count}..:
s •�� ,(If city,give street a ress)
Name of deceased...
ngle, married, widowed,
//II 19ra
Se��Color..�i>�..77..��. divorced (write the word��.� Date a D •. •• � `�`
Age .4 Years.. Mon s... ..4' D ys A Birt
Cause of Death
Certificate was signed' y..:L.. a... . M.D.
Address../.f;. i.yre
Place of Burial (or Removal) �; l., 4
(If body is to betemporar . d, fill 1n space later) Q
Cemetery... �.s. Date of Buria 7-.0c.y` 19
(If body is to be temporarily b , fill in space later)
The Certificate of Dea con*:.fining the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing tc, 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
Nun r, and,o the41._ ,bb sis-then l;'HEEREBY GRANT A PE IT •
ame) _ (Address)
the.. de-e— G.•i.T'44:40.1fCo hold temporarily nd the body.
,n4ertaker or person having charge of corpse) ante , e,9>�t�erwise dis*�oae of [state how])
Dated(/�C ... 5 Z.3 19 -,2. (Signed) Y
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.
r.443 . p w •-w •y y e)c o 0 E b D., 0 0 0 t••�p ti xb y w •, < n v a. » ... d,..,•j CO ',te r
7'n ., - 0 rl'7 n p •' •». ,C _�-^•».5 5 rc p roll S n n O �Y . .� 7 F tr' O
tv
° 5" o co .< 'c co _,w 5+ � -tR1 Co noa �^ y O o 5 ao �� "d_. m M
n -t O C — n 7 n `i c'm-..w n n < O •n O b ^t n C C co n OC '�
iv p n nG-, p.0a Acy wcm..., p . �05 CO co, , e, f9 :,�~� a--r) v, '~+ r.� CA n1Tl� 5H ° m Z
;Vz •*, <ba• nw•C,� w '..o.y 0...fD ytVnCAww �� � 0 o- c.Gw 0 74 0 " ° n• 0
'n. �.� y y p <_ N n N N •y ~n n a' Gn .+,may„nJ„y n _'� °�.n p O w r, 't .� Gw N ."•°N"-a.• * n V
�•t.- Cr i w 0.0 "" 74'w a w On ., ': 0.5. ^. co p F.T.
^a,..w< t7 2 .w._y n °.. ''V O v P3
" "3 .>! •0 o a° co o ay w ? = *2 co NN w < a �.Go-a° •a'n o 0 5 ova CA
•-•--8 n 5 con O n o0, �.. ypo n < w CA m w 7'� ., w 5n p 0 0 v '
� nco yw ,. nip .., *3'pd7Vco =•�'.y.—.w.< C -Ico .nm A z"•3C7a b�
-'� piz {Ift1tI1II
n § • °,C ., '-3nnMwn ,,. �wco a.' wi !11
tic�iG)Vit
.4 n y•5C 0Q Z o �� _ co co 'n n m y n O . mN •Z• � w �'•• .-, -,°.� GL< a »cya' 0 O TA Nro T y 0. a P-'"'.Cra w a , 5-, .'* 0 0 N o-r
n PO n o'c• cob a n`< -5a' N H ° ° a0 O t�H
.0 tnm C -,-.oaCa.wc.0 - onO-... '<b f: o•w e 5 y'-Ho0S:° coy 5.50 .GS 63 '^ Ot1B B A
C ° w8 .3 * N y .w C`< On pn50.,° 0o0 •NCrn• n5 w O �y O' C
p�C 0 a n w•5, `-; a.a —o w co o N-p 0 i u° n A n;� ,�-� -y w :w r° ''''' .,y ° 0 r„,- <0 g 0 CA ori
dxl`< M ".,?. vax' 0o ,; 0 = _..".,:, 3.� XO ".Z onm=w �i~, � a"ncrwoo y'� '*n Cao N 3
0.-, n Q O ». O n r' ='n 55 m •-•,G.'• C C w w n Cp-n .w cn ., C� .4,tY
0 Sn w O 't 5� O 5 , 0-..,+ •y ., y cc -t , R' wn• ,fa—n 0.w n' nis •i [D n 2' tnryw °.. O►�y
C T n �... n n y O O n V, .n (D r y O -� ., 0 H .. N ° z t'!'�
° co o Cp .. w"Co 5 -, an „ 5 0g••-• n �''5' o " M�'� ,00 H " a
yx2a �� F ' Sb r.y'C_ ; . �'.w k -.w w -I" 'o 0 5n Igz•, o $ 0 y n'V, o,_ 3 -, N tip P.•,,o an' n : , H
A 1''1p7C 0 w . —n n 0 .., n n G.. C co A m
yas � `' n5pv co+ na n o — co enco conow0cr (T7 :,-3»w = � „ H
4 .Th.3tT1 .;n 5;� nnn •, opti ,0 o-00crq r0 � dwon..oaC.< o,Gn� n EB $ AOt
• w n .. n C M C C w 0- n O =
•d vt �,• :5y 0 p b n 2 C. n O `o ,, ay n w ` y•n 5,_.•, 5-, O °rm y• n ` .: - W O
m CAM< ..w •n ” ; ° � SI l _.5 Fr w a�° w•~ Z.a,'`° w o y sa w w.� `< w'e` _�"e 4�Ci-� ` ^,~0 y 1'.��.r �A 7�- -
B, o 0-..._.oa •o a•O=R • 0 n c 5i o- w a 4 v'n n "� 2 R ,,: nr
'� � _, C 1.., 0-,, g; "y n 2 = e1, �`<W 5..`+ 5 p a' w..aT n n v-, C w,G n y y R n 0•n� n '�7�3° " �. ,, �'X 0
< O p w n - o G n 5. C C yb N �y
..n.� _7 w5 y O 0. n 0` n -S•� co n O C'p n b y -, ', n O a. G.r' r 0 t..i N
»`rf�B n' a °w �' C � �O C7cA£ nnwvw 'p 5C "+,C, ... OCn .3C"w .' O A Are. °
0 * G o o w c 3 t`y now o pa w , m .. o rri z►p
.12Z�Oa c?" y n w a o ,� o p n n c o . n •y ' �'C ti y•�, y.G�vb �a(!� co .:1 O �"]
s 50 5w n x- a o o -, < o o ^ n n o o ..r.1 O "tio .
'otonCP3❑ w .-.n'nn7 w :•, -, Ga;,•? .c• GC < `"C y =� B < .-0-.Cr' ° �+M�T!
ty �"no C ^ .oayco � Npo royfny' a' ,, no _ cob :., w -m-500 � m P n .* n a•�Vmi
O ., �' •......5"t Ft_.., n n`o b b b C < p"..."'� w o a..` �•n n •n-t •C P:�..� a n
yt £ RB `'.5. n O io 5n �W �' r.�3 rbD y .n, -cot 5C -.5n C.. 2 -, C n n O�o.F_a,a i C-N ....04 m' ii 1\ 01�y<• • .5..,to ,Ct O. �' 5N N O n �0. y 't C .: y8-P2 -,b y Vj -3 .. `, � l'i l•l 2
Or ce C7; ,n, � co ,w, s u m•-wt ,w -ni m � ...o da '-n -' 0 0 0 , n a•5 n �0•- 0.y.Cr p 0 H `..° � .•• Z
m ^.O '< n a)a'-', Ott y .0 oaw n n y •< '+ C a.w Hr. itT i, .
," a r r. .n n-fD n 0 p cob `t o^ 'a y o o-1 y'x cb t7. -co, 0 5" w a.N•0.5A a,t-tC G.0 H
o $ r'<• y3oyo� ' _ w ° "' w E �G p',;n, y^ o " cc'co <, c°, '�w0 °-moo `° � "jTm �Z
F. Han .5..iy w•o moo:a•n 5-. y .o: �, .•.� �n � •, p yoC ,-c'b 5"oy < y "^., ❑ cons xn oa u. A
Pz O w w ..--•co p'yC n' 0 y n 5�.n 2' n 'C 0 0 -f P, y C p 030 "` n ..,< n „ a•n G 3� Z m Jo Oy r�
tT'„UJ.. tD � �' OC �n.0. .n, OS ; 0.t?'-n,, w "^.cy -'� to .S 0.^cot 5'�"� C C Ong O 0 `Aw
° O, c• abco �•$ y co ° co •co y o .. n •" w `0:n n .,b 0 W.0 e.., o "3 T,*
* non • •s 0c .=n2....T.a,'S0g 0c`<.< .9 < 7 _'n * cow yn •, •Gy < -, py '"'.< �,.m Xi
"°n O N n -, p±'y N 'I.C '�'.n, '^' C,.. 0.a,0 .-.�' '+ O-, a 5 .3u O 0 Er G.3 W w X S "�.
c4c " c)c•...ayw�ron2 � `< 0o•CyC ono� o° H �° n'z^•obm ^< M"02� .. Cr1
'` " ^�� H o w o F =° e < °* o ti y �y �.w -'.y < 3 ' c o'n o•O Fi•p u, B o co co G . co
co n �° C, a w �.ag c agy w co a w•w, ..rn.S• ° y e •aa.o " aoTi c y 5=;� N „N 0
0.h-°., o va ? cow {A 5 y ca. n M 1 co a 0 W k<n c•m o a.5'w 4 w no'•O -,-t a a•c5s a va�B 'T1