Loading...
Lyon, Bernice Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT tor 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 CERT��L , IcAJ OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. '// Regiatere x� .._oc Dist. No... .4 a/County / G2h .z,,--%...r age ..e4 f 'l i .rx , e7 lty (If city,give street address) `%� Name of deceased .. .. . .. ": ��`` Single, married, widowed, Sex.......,. Color. / ........or divorced (write the word) .1. :,eGDate of jti9th.. - / 19.. f Age 4-- Years 6 Months IQ Days Birthplace...x!/.ra-Abet-.iti,... • 7• .,:..... Cause of Death.. LQ =� �J,�istz-, Certificate was signed by..a�� .ollf.:. . �'!/: • . ... .. .. ... ... .ter ......R Address o 4 '- Place of Burial or Removal .. ' F- (If body Is to be te••r.rarily held, n space ater) Cemetery.... l..v / � Date of Burial... ..../1 19.,E/ (If body is to be emporarily held,fill In space later) The Certificate of Death containing 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 stated Registered Numbeand on the basi hereo I aletiE=NT A PERMIT �� 4-11416412441 ame ass) j the to hold tempor • y and the body. (Un aker or per having charge//of corpse) (In the siose of[a a howj) Dated .., lY 19.r (Signed) Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation of a b to any part of the State (subject to local cemetery or other reOlii i...,ll_urlPPa rww...sln1.. h. � •_ _— _ 1 ...- _. ___ _ _ _ O ,q g<r w » c "�J°,G •gG,n 9 O .�'cig F.','..O O �r1 p � o nn a-a -. r,,» , nnFa -•—o . a' R ry ntDI > o o C.-• w w G w t°'ry 1 ( •oR cm •i~ ,1 " a•° q o t 4.. c ,, p-0 p O 0 " ' y , ' 1' c o cnM xi • r.• p< N,^ o ° °ww0f aOA2y .5�, . oc •o .• D .�a rown o „ pri< MG ror, r° o w �1oOoan p�ac •A• i7 • G n- w mn; :.n, n . •yno ° -.Po. , nay Cwn ` coa• .. , zw " -I ow , • CA a a�. Q, 0 o0 ig� CQ ° � 21 'Oi w 8 •° .Oq ' n 13 0• r. o • ' ° . „..° wp „ . 0. `•G •i awC o. re� n0 .- n iIj 5. .'+ 2 -•• Cna _ a„� ,-'< „o o rpi m u, u a- w .--. . 'y 0 I � •. Icno G �„ » ° • y °"1Cr1 �.a•an G -• '° a'y' o .T.g n a -,t " .w *n 5. -cw o • CA r, "1a •' - mrri7< y „ �' Emm L" a '''. � , oO • • nn.-, G1 !Fh1 Aa .,•e`�� n ° OAm Ea ocyw,r) - gx '2 '_ n " oyo - , 5 ,... ‹ ,i ,n = c.r a L,P ' . o p .-< nc - ' Z CO SD A>o Mo o 0 oN � ` ". D, =o er o Ca•-. — z - , goas4 •Q•" w ,'d a to Z^ o o p P • 0 P w K ?:0,: 9 n -iR7 G :-•OFir,,, O -1" C'm OOw rywnG. Wnp r:cm , ° O'G0 6n * n . n " O.m < ,, . r+ x ro© XJ cn o a5•�y ,.w piO w p. . '0 W ' _ C b vo ' C X CO C r0 .nG .pn n.'ppd wE'Y 'G ° '•: 5'. a Cr . -, On m, t O fC'O'� " .-. ill " r+ ril OnOn " " " nM 4a OrO• J.ayC D O`< coa'+., nor o' OpN nG .,p wO O ZR7 T.OZ " '0 G ° � ,.� ° d tD r. 1 -. a � -, c� Alw wr.•n < aoo , a.»,c � co •o ,-, • tsj o ro w• n-a °• n N w ' •0 oo o • ° ° no ° ��X° � '114Cr1on Z. W nAw Jw < p , ,-.. , 0apGoC '< -1s'n w a ° w w a , o ac n N •