Carnahan, David Form vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
cr This Permit can be signed only by the Local Registrar (Deputy or subngistrar) 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.
Dist. O 2 Town /�
N�a. t . .r - ' 1 Village C/
or City (If city.Rive street address)
Name of decP !// Li-S
y�/� �/�f�ingle, married, widowed, �yJ
Sex'/ Color or divorced (write the word)!(.f42- u"-'--'c Date of Deat da79 194
Age G Years.. ;,on .... AZ- Days rthplace....
Cause of Deeath G frt ..
Certificate was siS�4b�,y ��� M.D.
Address I-r� '�
Place of Burial (or Removal) „craw-sr.R.. ..... ... ../�f
(It body Is to be temporarily held,fill In span star) �//--
Cemetery Date of Burial ( L 7— 19 7�
(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 ted the same for 'strati have recorded it in myLocal Record ' the above stated R * tered
Nu T y don th islVt reeoof I E NT A PERIT `7
the....(/a. to hold temporaril ... the body.
( risk or eri haring charge at corpse) '!move, • o f' se di •• of(state how])
Date��f: f l `� 19 G (SignedS_ � .
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),unfits remooa/is by common carrier,in which case a Transit Permit (VS No. 02) is required.
„rill 5:R p "� a T"ggy�_i ..s$ ... ? �,?ngsRg .o� u3q Egaof >gi�' 6 ,at^ •• en
• D3 a � &.. p $y 'L-'r g ^ rsTnoa ,p„ �i3a=, wav G', n3 � S ,< < nn.
z-. a^a,Coa �'w w, e -.O'nnS^m� •y Q < _.w yw . n...,� w oa^� w% M1 I, a. z
A : SI a ,.$< oa an-R _.owE' o o -- car. RIna; SrE ; o _.r--5 AAAA o
7,• 'am p ^ Myc:E. o,^ `�,vk ;' r : ^r'x,a^:e^T=.w^ i'i°• °p.,n S„;,, ^= = 5'a0a ;.• 3� .'.ev I
•
:-4:--1i r�R3 ,_-1 ,'g3. ,sae G390 .R o,:.i- g- .. .= =mat. ,"rj'^< t'Bs�oK Az4o , _ ,�
' 0,0 n � "Str' n ��jj'' 09 : nyS -. •Sod°. ^ ng5•a'�s S�—ww 3•c - }Q{ • ..j • • �w•n
Set _g'nr^ ifj'Y =3Y .°i.t ;, .4 -0 ..g - C.”' g .15 n ,.-.S210-8f ig1 .1 (ns^ 03
ire; enizw45, ax ^ -^gain. Z..R 'Ei'�en '•' g AlnpY ;En»^a-�, w u5.° F 13n� mm
Ic'• 0 00 ° onS ae' 0 n � , ^ , ' o $ y »C'nw5Eo =i� /`�� 00 .z7
s '.pa o <' c ^ gnBY $t: - 3'ppcnT- n9 ° z^j� E a ^ �,2-o RyOO^f o a • ..y]
,S alc "yAgg; gor ^ Q_. K'awn C,a=C 3 -'u^ aiOY S,an 5w,y 5- y �� N^ O' o ^�C �w•,_. a , o-a
2 O'p .o 05.6'�.R �.a N„$ Y no _ g -(1G ,^i nr- °., , ^ o'- amt..'" at3 ^'^ aeO g8 <� , -it i • `n0
A �r1 w � go^R �v' �,:n_.Wv$' pSEna„. .,& ° GL '�1 5^ Mo ^� Ott
� of coR 1- a , ^ a. •q' gR-F.�-2 ,T ^ �wa , a »g < •i rn
:m• Z� ' og." 5"-E.^QR�Ra E_'.n $2.:a:
,' go • nd•m-• R$o�^ nr 4 s ' 2 " 16 yH
, .°i ,� -•gRgg' n $ $" ^, -,� ,Q^ogAzga' y7^-, onRo' o•E it m f = f'g' i1�:
Yw . .P �,nrn n 2O R -3y yY , E c-2 �.��'
e n ^.a a^3 rw�nk C85'" �'-L ^ C3aR.. Gcrr� � E.. •.. cd Inr �t g _ ip
• 9. �o,L w a o e o n owl- n u Q 'y ^ ^ 'S.O
.7° r Ea+ a < . K_., ,rT.'»^ g'< e, -^ 6 �'uu Ean 0 $5aca3w t). i � Si '�' Y
..ia a.ria61 ,-S. wbLn no ^ w,., a•, E -3' von `^ , n ga r. ap �j • ' o..77
• ^ =o' ^ aR�ow E § �o '+ o,n�fn � CC R ✓Oc�.^ ^ � o.a , - s dv ra° Z4. '-g..,, -. are 3.T.»4,-'5 gggke'<opk $no, E5 E. el,5a °a.o�RK.CT oX la •.0•w7 ° ei.i R1
7w g, MaEi&r. , n T- , a::4c, 5' a � " n3 ,3 ��i ° A$ m'ne n• g=_Th.o Sa ^ ^a.,q lici §.^ Mg knegv na e3,Tti ). g0 • g3 ... tA
nan � � ^ nnvRCf u •Op,' S„ ^ , ..� �' , _.7. ni3 <i 3Efno3 w ° 3 Rw 8n � ga f.�� a 'in $ 3 c ^ aE � o • .pfTi 0
o.n Cs ^w• O ^rsQ �g'SR Pi '6 °,eA3 .: ^ �Ro.a..g g Sash- vXka� -1 i .," o'± "±
R1z2
,•. 8'Ot^� : ' n^ n o °-Ana o�3.a> -- 'a^ °_co$ie a2o ? ..=.0, u •SSf : F, a°a�C) $....:.gr0 f y-z'
E re al ° �8 o a5'^ "n �$ E .Y^.o'S:�.°'.�., u o 3 y o° z=^„ n M o.- p S ff//�i 1-
6Y R . av�• as, T i yn o o . ac »o- G' < -,< ncxn _ 5S� z^. P r' Y
O ., -N ,7 P o g S C o , F.,-E tut,.!
•t ^ n a n 6 t'� Z e e C' j O
el
•t25. 3R $co% g, as2 '^,, $s. nB6, '.6n .,,,R p ��Pr C'� g',S'voaca-° es ..1:.b'.g tv 717
2 ao° ag�G. oy �•�fa,o °,?�`o r.r.yng '^ •- C3 n , a« Y ^ o '^ S e j .i 1- 'N
Ta3g 3o $g-'a -»;oi4e• nrs5 .o, a$° " a > 5c 'n ,•°. Rw "o MR '• l < • z^' r 6f
! , a, u ...f4 a v � 4p yo u,5.g 3. 5e3 c ° 5'^ o-Ono$ 3r4 •Cg. 1D O
a °a swg:,' B -.�5.Salc E'^ pa " MO 4a;o �nu $E.:1 4
4AP.. �g;1 , §� 1'-.��< $ a :, =feFA g, ga5 ;aoae;. g-„ yawl - .•6 1, io, "i