Lansing, Robert / ...,,
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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.
.�j Town
Dist. NrA1-4 1 Count -mil Village 0.
(� ,....C:�., (IP clty,give street ad ess)
Name of deceased 1.. ..... .... .......... .::. ...•'.
tt��.f1,,�� Single, married, widowed, t ,,
Sex.11. 00....Color...�! .or divorced (write the word)... .. .. . . ...Date of each .- / .19.tf..,/
Age co 7 Yea s 0 Months f 4...Days Birthplace.... ... r rl-
Cause of Death
Certificate was sig ed by... - M.D.
Address �� • �..r. . .... . . ... . .... ..Place of Buri (or Removal) `y
pofarily held fill i e ce(If body is to p later)
Cemetery.... Date o Y...Burial... . !6 19.44
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above st ed particulars, having been presen ed to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for istration, have recorded it in my Local Record with t above state Registered
tN r, and on this of I HEREBY GRANT A PERMIT eZ. CJ ,/
f.
the to hold temporarily n the body.
e ve,or otherwise dispose of state how])
e ken—o persgp-having charge o corpse) ( [
Dated 1�7, 19..L./ (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or e of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier,in ich case a Transit Permit (VS No. 62) is required.
C'►1A 7A ° w O.03 w tr n O E'g w O p P n r,p h pro M w w ^, < n O a «.. 0g Hu) ',�^
s(. . m -. ,. » .. p- • ..to cotoo•nn o f. 5,-0gao C p C
2 ,'L'. cop o-pP.t► g< pGcop ny n-w �,n »,° 0Og . nOga .. to0p0 C• ,�Dto a co ,i �f
=Zg a '°gibes 0E.oN '4' :I=mmeDa.�'e`wyw~ ; < •; `.. .6 —,D °.»o �� u�iE �� o•Na Zy
x - w 0 .-, a aw.r-. t. -*.1 i 0,....00'-O WoNNnnwwtaww.o O� �,p'^, (]. W G 'pZA .1 G a.• Q, V
e .�+0 V) m ���•< yn °fw=° y ��Yp �WG.rD ►nVanMrv` � "OgtpiO•� w ~ ,�»0 �. �'V �.0. ,.a~. 10 0v 0
°3. w o o n n o p•_. o •rn , n p aw to h �o
:: a � .re ncaow "'perww wo � co < an. � o �p ►nC � pc ° 3 ��� o� rx Cr7 .C�o
0 1 CA
��Q '0'p,-,olii n a°,�i �° a n N R. co 5.0 0 .°.. . ..0 rC Vn {��' �,-. 'y ''',,a 0.
a, < O .1 f. 0 �•n A 04 �ZHIV0 �,•,
• 00 x F, ''' F CD St c xE 5.�'-'a4 w R M.< w C *R'c"'s, g m n y am•••-� C•w•"-.... ac 2 XI �'o u'>° 'A.�i
Q'.y n •Sti aa•A Ava 71F-]n Ao wn w - n ,"Yww'Ow t. reg ►G?' CI rn
r0 A V. �� "+ p w n A 'z- n y+'p'C ~ O twi w ro ^n r9 ti w �� .w a�, K e nN0
o C" pp1 p,to a w m n w top r., ,-."+ 5 m G + ti ►�1
p t7 pp ° •O n CL o;,w...O n'o.0 n m '+ n O 06 '� W0' O r,,.•??,O w p ,.,yO m 0 rx�moo a.7,].
0 'C O., rw.tron .0 0 0 1 P.
N n .1 m a-. � C.-.0-z .p�'^ •.<w..'.. °'.'"•.e., Na~ '••'•"'.p'.~w. .+K • 0 0 Mq 7
'e jieC -, -,dacaP,a'g °, tnc',.. .•C0 'P—oo a � Ayow pnwppe •Al '-'0- N '" wgR A�
rma ww is is•rya,ro o •..... - - M0 ° :I.p 0- 5,,°.tio.ti ►, paw co wp° aN a • CT1 CD
d p �x...ry � toa --owtoo x nA t� o'n w o'tcw O <o... g �'=J
O `m -"Y.tD w -t d•t.Efl
' Cto w ' G a Y.:toO �,,, ..o-.+'+ wZ�1
0 7'O tiw ptna P..wk -.w K
An n p .w O ..'�n ,-el ti 't a►n� ap N O sr a .P'. "..CH
4e to '-^p-to ", n cn .1 w "' n • n o 5i ti o n o` << row ►,` Di -.•-]�
'r1y O_ ., nto 03 , crppatacn , nw tc .. v aato e8 E 0Z0
y e• =000 °.1 " nr.2 '-''n 0 .. �•Ciwp Mn � wws C n w � Jt�vnxo p�
p ~.O 'pJQ " (Df9a.. N row ? < Aw 0O00C4w ".w--q0. 0q0.+ .. ", 0-a.rr1 b - ' AZ
my 9. p0 �w wa •wocoff. .oa �•po'O -f 0 5'w » �s�- w wR � �, nww �3 x n n 9.%.1
' "Irt p.e a p'"p"w S aw p .n, °. '4 " 8-" * n 'moo �o co'E ,� •, to o a,�C.ra g E ' E Xii iA
[Ti71 cu,'•'T, to to w w .o p"o'p C ►n rD '+ a w ` o b1 E -
5" 0.p p• an r) ?;a ° tin $ w n to ..0 0 w now 0 n r.r [�ryq n w O e '0 �„
'�� �m '' n wa 00 tap "..nnw GO �n ', m <'C .-e 0' •� �n aCroY ^ta'Or Uj .. .�. e .+ M u ���
w O a w 0 to ^, 0-w 0 m' '< n 0 ." a i
ri•i 0 v
� �x� 000 ?_' .*cn �,' » =' p < oo -, < � o o co pa p o , e .. 4- LTJ
to o-".• .1 , � to eD m.0 0'o rsb o a w.,•-• tie g aro < tron�`a...,F2 w " 'a� x o 0 Y m ° 7o � �
ole n C 1 a.° ..j•wM 0,.'t M 0 to 0 fn ° 0.,....1 ..-8 nm .r 0 4•7•n n 0 ICtoh Ito ►"...p'►, nr. a e�'p row' C �, o o' to yCa a rei A r'7. 2'►°..u0nm„--a,o5w, do .w. ggtoa w " N. "1 rp.g-A .9ay'a. cn 0•ya ~'r' O
O'Rdej �ry ..,wy " nwAti0 '` .4to O ►.�ek -..oa 'a- O '0 °4 co ,°p. .-:00.no.gna - ; 0110 .. �Z
os.06"� Dr 0w'0 . ',- --a p �, poory7$.k. p2ro ) 'clny�Ow0'� � ° :910.oH"" � 'eo Z�
06 nro °. woo_ w 5'av, ,.% n rr'., .' wo •� < a ..oE � d' to � � ..� 0 "1Z
< y'gpwpi, -, ,,. � 'S 0. 0 "...1 w ° 2,p 5CD5fDwo. °qow+ ",w to
w � » ., to ., p'n0-m 4 0Z A m' o w0C C .t5.''.+ y < .n�~ Cw •eC �.�� & A
R m ro a A �' �y g.In .f- ro O to .+ A g
F,q 0 §.►— "'cnO'p. gow itwoOg, W~ cn O'C ° ° M00�.;igQ p p < to Pto r xe on
e ,. co aF oyF.s'.aa .1p e�n 'w'.oa' v~, ►•''o Fnwwnw.•.' °' cn C �O [y"Mpp .� o,,, d ��'
xn a ,,�'m- o .. =P ft.•.-•05 0 �.< o.e N + tao �+ trut o° pw ��, ow » �i R R' .�
0r. w-. c} O ^-G� n h a O w o_., o'O». J
:�'+ '�rem .i N �.S' .a.'. to ?�. 'O w �., p v, p pp�G "'d '•"p y..►n.-., N e n ia
0".a p p n = a'w ^p•� CD o f(n fi'CT " n o q, a P1 vn, .9 A M f0 c ,R w o i'8 p b rti v til z Ci'1
iea 8 —z, a.p .. ..., p ro :� ., wp'4 6' � � � a� �w � O= °�° .e, G5. ' 0
y�pp ►Ci �.a ss*o ma.$'GS w CD ;; ";P.< 0 w p 0 D� 0 °�p c w p•-...0teP w ^ �`\
a r+1.Qi, pGr E.p''1' ppp H �'y'?,�'•°, 2 :+;� C two D'w � O B.n w 4 w a-O.`�° a.R�= v. 0 "17