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Pendell, Mae Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT or 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 o._ .. _ Town ,..._"f Dist. No •a./..•County:�,1.. . .. Village ppr City (If city,give street address) Name of deceased .. ,,/ Single, mar 'ed, widowed, -�/! Sex ..erYY.j..C`olor...6 or divorced (write the word)./../. . . Date of�Deat ..5 . . ..1..V 19...L.A� Age. .43:...c..,.Years , Months.. . v�.,.. Days Birthp c Gam/.. ....t. d�, Cause of Death ' ....... Certificate was signed by ,....i: : D., Address ���/ ..3.A.. Place of Burial (or Removal) Gi(/ ... . . . (If body is to be temporarily geld,fill space la l Cemetery' - LAI D of Burial . / 19 (If body is to be temporarily held,d11 in epac ter) The Certificate of Death containin the above stated particulars, having been presented o 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 tated Registered Number, and,on tIm basis thereof I H Y GRANT A PERMIT fl to ., D1 ) (Address) the . . . . .. .. . ... .. to hold temporarilyand...Le° e body. (Undertaker or pe on having char a of corpse) (Inter,renpove,or of erw a1s:o of[state h Dated.... ..i.. 19V 1.) (Signed) \„.Q.•,...L , ��4..... Local Registrar ,-9- -K.. This Pe 't is sufficient for the Removal (and Interment or Cremation) of a body to an 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. Cri r+..p0 ro o w •m n O ro -C O n .+ a•n M nr n .. . .. a cs n n eo o �'r F ? p C A =R � � �� 0.nt"o <oR � �n '"� W .. .w -.,O -r Qi �t nog0. �ynm OOto a"' aA chi? ii a >5 n3 _• ae -. awaNaa�. :4o-ntscp��em .W; � e .� o.»'ao.w'V2 o3K ��, �E j.. 0 A 7; x 4 a 9 '° 32,0.cro yN anw "'" •Won 6 aOA 70 w ..o " 0. w ., n ww ..o +der-•pwn- wn •, °' w0 0 -,a«, o w o �xA p. o d A y `Ga•< p'° .9,et np•<" y..40OD?L7a0..rOeE4V^nn�•, n- G ~oun �..1nti �•0w coy 5a n OCRv ter' 1 ��1 in eo n ..4 < m M .y ..,• n w 0. Caa s.1. a ° .n ° ° w , •, a a 5'0.w VI 1" 1:ja A O .• ICE wG.w 2. ..,sa S ., • m p •t 2. 0-5.• ». n0��'p.-..< a < anw no,,,, 1r°' CVO v ...1 >C 5.� n n O 8 p w W n 2 n N. w n n 0.0. :a g, °ro .rr''P .C..o. PI." 9 •Q, LZ � n n no ?.a " p.ttP �Ye 177«r. ry 0�''•..w ay..n =n ro a •, H n A o w n O er.rn n '.,, m , n -% yy ro . �r 171 rill ►y 6C"OP � �04� "C3fRi � Q.� C. m A zmrtw.'te 'F+v, w No �• n ,�rt'so n+-iv' 46,-. p p 6Otp.O� NIA Ae+ 03. e'Si a0' O:°.•' c, ar�. Ea9" a ; w.oh 0. o »nwa ''' - -° „w5'g no ^'m 2 ._ a. n .-1'c '' �vn ,, y w « o0.c '''' n`< .: a•D; .°, t'I o0 8 M0 A AC '14VZ0.5s0.o ° ancr... ►C�l .r'0.w C 5 �' ow any ° •w .�.r Vl 9 _ C O ww -+ n 7s• m yC < p Ope .. n m0 , 0Le , �n .4 m 0• „CO tr C 8 O 0.41p " g E•ro,�'.'".-nf AO.,a ^'ow re oo VP.'•'" ..ry S, 0.no acr,= 5ff yw .n-t.Prr1,oma .C�.. O ©,'Qeir a �� Vga To ... a 2 3 e + c a O III cl. 0. a Mw .. gn g0N : "n n5Cr : a w � g » .,.nn ~.,. 0 H R we g M Z• "0. , M ....• t W ° ..'1Q..-+ Q.Q .f p a•� p Dn ~.., N 7 0pgm .nA y Na. nT rn -y'5. " n O p •1 'L r° 1"nnAas0Koin ° a•'9 ,i2 p'Aao•a � 14" Hc>CO xanp owynp k � w " ° ca � y . -- a a.w . w �, on' n , ...Cc.a. o ° F ® Cl1 ilt 6H. re Aa�O mDQ o,0. "° 6O : a 0 nn n a ' •, p J ' -0, w n '. a• : * WO a" a A G w WtaOeR� • ` '�(79 �O1w:Si'T - n n n n� ° m '" �w m eC2 � n 0 . aa- S00,17 •-1Crn pri .4 ,-. 5 ..0- ` ,- o' 01:7;a0� : w w 5yo I. a ° xH 5.o•-iw W g ., ost 0y .9 ,^ =O"1 0• �'c °. „.iq a o aP .o Aon ° � a *Ow, uvin ,L.". n > A 'VQy1.a_ a 'nPqS$pn � y ` p � .-t � i. n , . k g B h XI , 1, ° _ LL°f W e1 0 .9 .. 4 ' "" ,O.ncr0 �RDV ,& a,,,O 0.CG.r gm .'rJ ' GC ° 0. � Z w o- a Cc " . i o-n o o A Cr1 7 Mel' =a £:,Q wC § . ..A•+ B ' n p •n0.CM. " I. r n ..�N T •t . Q V yi GroM ^, " rH Cr E. nil n ° v F aaePspIX.`" triP:l Is almil t O+ n E.a o� VI � ro Kw ao $H • ri w ° " a �.M't+1�A C BMpwn '° � n �� . � en " a� u" SO eCgnocr —cm " O r„. • v � ITJCrx 0G D o. p4 ,ti'RM �° cew '" art"nnnw Oa C' ." . aa1 n,:r0 , ' HOC LI -i -io ? -wa3 , o .4 • y � •, ca � � A t/H2a ..ro ; . nfrn ^ ��' un Aro,C O» a wDg ° _�D .a o 5'N » ° .' ' ° � A e .� �p �r � n n nyO mo °' H a5 a » - O� o,pnd ° wp �° ar o . on «. vn x m- •-• r. no o rs r. S. w. r. '14 P wt -ii1EHiI p• , anSaaa. o s /� 0 0 •�j1'rt P n `• 0 r.a n •~••'� .0 a P 0` 0° a•rd y o •�Q'a.t774 61,60 N n p n H�....'4. 'tpo ry ram' �.i ,+ ri Y3Q Oc� a'» �'. % °`p<'g .n �.+^ n rt.... 8Srnni ° n •+ n = ...re tl.p ... Ona•O �J4'"r'1 tp Q�jp Hs~�• �.Q..[�.a• Q f'"1 a. w'w.� �'K•C. a .G• �3.. r ^Q�'rpj„�D y .A. �.'"'„�°, y py+.•���v!!'11 O t>VLT1.& � A?'� ' 0DOCa5'w'O•e $-I to ::. .rt1o � 5'OCC 'CP, 5 Fa.a'w4w »ni � Oe�i �wjR '