Brower, Elizabeth Form Yd.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
It This Permit can be signed only by the Local Registrar (Deputy or subregiatrar) 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 LNK. Registered No—LIkik__
Dist. No.'.56 ° 1County Town
Wa-ledt"••• Village..P
N -ral ,A11-1-1-14(1 - tAlt4,-• Jai,.
.
' ame of deceased a-10 •0 e /st,4727 (I city,give street address)
ingle, married, widowed, _,/,/,_ .0
Sex '''' • Color r divorced (write the word) ca—cir'''' Date o eath 4e/ 19.46
Age Ls St yars 4—Months 0....Days Birthplace
Cause of Death . netc.tr,t Cr+ C..C•r er‘111.4; lat 6 S. .1 ei* 4tPro+i- 14.
Certificate was sigittltma •, . tr.., I.D.
Address.
Place of Burial (or Removal). 7,0-4-4-'72 i•mA-ce..-C, eceirrethat-,
Cemetery
(If body is to be wily h pace later
6
...14.1.4.) Date of Burial 19. 0
4.0
(If body la to be temporarily held,ill In space later)
The Certificate of Death containing the above stated particulars, having been pre4ted to me, after careful exami-
nation, the same appearing ti. be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have accejed the same for registration, have recorded it in my L Record with the above stated Registered
Number d n the b is reof Mei:RANT A PERMIT
le,
tO
dress)
th to hold temporarily and the body.
rtaher or pent having charge of corpse) '7 (Inter,re ospretberwlee die of[state bow])
Dated.. 19. flea (Signed). S."4:' •?Weir
Local~strar
This ermit 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 earths,in which case a Transit Permit (VS No. 62) is required.
^Z° 5'8 : wc>4SFr `-'.cno7 3,tsiit.^°•£9' r ^ FT.� ' ,4 .1.$ 4�i 3.3 •:sF p;„'1m E ' O
•� clan nn'4 ^ n^ cS.'t.w ....sce, -- ., $was ""4 c ° ,72- 2 , Y '�_ > m
y23' ^ a74'3 96 'ta.6C S,n W00D� =.w-.-.Sn ��pS`•• 0,NNn - n3eR,Qwaw a^ Off°:.55.0 na
y0 xz'fl w0o2o ° 2
y° �'mfnunY= < anoy:,'R •-• , to: n= n.-07, - V'�n -, R-t c '�o°6 O O w n S^..04 >L` Ya.N F.a.A Y 9& '., O
••en� m w o ou n + n toes o -.n
y..• °
^-i' X =. 7naon-oa. n ; a-' ^ n •w^ 2.N� o r.M1..,n £ o6cs ^.Sno'3S' h1 z}.Gvo
7. K S O.Y y._ 3 s-a RI v a " , .e? o _% .s^ .N n a..-. <.° --_ c c•n < w . R 4 k � .. , I*1_ _ o n _ 5 T- $�< n8n < ^_ 2
-'� 0002 n •'-'n'::noE.S'd.-33 ^� -c R§ el .:: " .p n 974 11..4.8+14 in 2 � ..l g-° v.Dn '.0.�
arse +- i,,QSgnsa^c•^ n 2;,;RW S;� t` ' gu ^ ngy5;n '.^n -ri.g.£a�.5". . pe000sit tnm
y es 0 < + ens -.ne + wG E '=•3• taw "'
ae ���• u0 £ o3 ,^._o ^w3 ..,A + o +eiv! 32
^ >a R -'co + n + a^ taw u3Cc• £ n »'... c-m < R ..1 0c Do N..1
a tonC -, u 5,oxg= `< R•a" -e D0M- 5' oTo c•. 5• to [° B A
c.�_2 : 8S w''^a'b3E-' O • 3z 0'3 s o� 3 a 5•^o T. .,R 0.'" w 0 E-£ ,<„+" a E'" c O6.0� z t ''1y0
a.��0�n ?,' n o�o°r"0 o :: $ wno jr3 ;+n FO ^1e n 'nc us6n T-'n'ff�;,aR ^y rdt am nm$ lT1
a SZD y6^T+�� o ^e > ; '.naRa HD !Ei
e Iil1ø:Rit'JllH
o^ge tn07C Uo3 $,o'y ._5•ow ^ o c- g•vI,�zLA w 8 ��' tf3 :.5' � � � �° < v•'' •aS' ;Id t 3' OZ,.' .2
=y .e _ 5 y'Y - --.:o - _r:g 2.� .. n '-' ^v a �46' Y_e �C, O'c. C..O :e tang
no _ a.r ET, n.:04 j-3.-'w .. .o e'- zio ar �i` 'F.' •wR $ ��, _�l _ z `'t G .T.O
_a 0 i F a; ° < w 8 :.N 0 a^ i,<w C a ° o.•4 2 " - 5" n G ,7, ,, .- 3 T.+a 3 ...
++-c.. ..:n�° 3" ?" Ratio -+ ^ - ft..."w560 £ °" co "8 ,"� 3w �o'=aP . 3r ° - n Z.- xi
-
o•n26 >. a37iwo.g ' n -t30, an^=.0.3Sie 0cd°o 2a04 t RR n ° m^n .. o 1r72'y
+ zz" S^3•o='-w_�ew-3,"3,e s00 :.- E o "q<°0,.=5•; ao Vo� a4-0 c''Y-1I F'on: ° i' i ° ..IIT7
G In ni n n C -_43 ..o S w n O w.•o.� ricAi n._.w S E.
6 ;$ < A R 9 '- -.•E— + S-.--'0 0.� •G n o n• 3�cA
n cn 3+ n n n n c w e, + y is0 $+ S^ n n. c G.t..l w'.S^ ^ .'D 21 Vi
S <0 3 =.En03c'" =w O";3 R 8R8+ SI =_.9,,au � R' .o. 3 E ^• v'noCa£ p.n•.., 3+o • 0ft ' +'' 030
4•T�•Ei rtOn?..g 't.w Or.�.n inn OSN'33.n ^ ? , � ^ y0E =O w', if i4 • N ^ n•1n _.+ �2
onOn + SR•_' R 'w a3 •. uN._�' �•-n ^ !-ItL!tt
eS-a�o•ona ° •'•i.°. � nnA ^ ° A9 + ...ag .0,3X. - S£Y W . 6C6S in p• roo' "<' 3 'oa $8 •-..• uarH3n.So 4: G. e3•n E •, y4,o 5.. i..,AA° '^ $ ° 'A^ �`$•?; C}G oy' o.u.o u • ".o0 < ;' .' ...v. 4et�Ns w - -^ s8wonnon. •2 n -•pa ; -f' ^ = .w.nwO.ngni9 Ow $_, , C ,..�a w_. r.
11 n2r a$ w 3t;+ o 5c • rn *Mt!: < c tr.
n O° iu•• nn.-yny O..4O B'0... O-.? � p ^ + in 00.xXl
4 . ....._ two _
��n ^nnP_.° ^ w'^'y'O � 3 S£Qooyw ^o y e 'O^ op anonz^� '^ R -�e Me CZ
o3e % °,cRi rile Rgoo on -- s-s _.w 3 C < y7 c c 3'n Po - e$ 3 Sn ms 05. 4 ..
4Ec.tt a^ Eno'G +n wsw .:'•n„< E.
ro':0 .nn `d...o -`n �' .."pp.oe.... +
L . ''->'4 i. n05Oat• 9. nwi° =n05A seep rSa•=o a,w4 w S°.,•^u0a,1I ve.! ` _ O
n� do .