Weaver, Algie •
orm VS.BI. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Cr 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 CERTIFIC 3 OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
Ten
Dist. No...1—h01 County % 2,4 Verge .c2../..d.T-'e1,lent/ '
���� , of City (If city,give street address)
Name of deceased ��.""" Le' / 5:�`1a1� .
��.yy�� �r Single, married, widowed,
Sex...7, Color 1i7 • or divorced (write the word):. . . .Date of De th.. 4,7 19. +�Age 4 Years / Months. /o ays , Birthplace... ... .. .... . . ...,,.... .:.... •
Cause of Death Years rf.. . .. . •_3,�t7.44.r2-2G ig-a. •, „ ,./Aiti,M.D.Certificate was signed by.... D
Address 1. -� 1- & .,t - ,: :
Place of Burial (or :emoval).... . . ... /....
(If body is to be tem/ y held,fill 1 e later)
Cemetery ' ,.,Cilt ,,r...4G!/V Date of Burialo(21-e-2,--&-, c 19 `fZ
(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 accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, on the basis ther I EBY GRANT A PERMIT /f�
to -el C. �x�rCrf-'v -.7 j
( me 9)
the to hold temporal-' nd the body.
(unlit.or . rson h charge of pse) r remove?oy�he 'rw a of[state ow])
Dated . 19... (Signed) �'C/ - x._,e3`
4 / Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) f a b to any 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.
cncn oEay �o0 s r"o ^ � " v w " e 2FS:D: prt.•.1tn
c x a , o w o.a . S.eri, o " o s ro o roan D o a 7 w.o " tz E S ill
o ,9 0
x, ; " " ooaro reroo � roro o :?". �•� -., e.,f "x °-'•o°"•r°o0 " roo ° pnc Y•roaC nA� to M
wy3 ro 9roa w " ❑ � �ww�mci �'� � iec-rarm �w * ron v'—a caw'� y o ryrt� .. m S o ° _
Z.".' n.RS`ba ro0.cro _ ro t e '� o ,-• � oro M
�d w p •" a5aw " ro Wm' o a Wntvnorov wroa», o°? -T;a" c w ° zro ° R ,°„ O
A 'Mp to m '7e 5 < 4 ro O'-e r° y "a Co ,'o "-.O n. ,°.,, n w n -� "�00 n ro " �n i' rao• R 8 , O
y n " ro- •" O V �.0. .te a
ti n � ,n " w .y .-. ro wa rpm P'-t.'. ao •n OO = rtat r.aw • rtw VO v
rt�_.X ni fe,e1, ao n ,. " as �, ' y ° "° cno [ aC ».Nro+ oK'" yEoasz •-•0-; ova • C:1 S �vo CA
'm '�a ao .ro, 3 " wc? aa-r, 0 �b0 .XOO'vN --. . rope -roigwoo A `C
7 G°.'O o g ro 5:a."n3." c'�o 3 m w e " c . ..,� ro n e:=4.,'Sy •w n t.," n ►� ° 3
O A Z ...n.w•.ro � a-.w� . w ,q O•n� w a •o.a ..c. to '4 (° ri, ro .X N•„ `r'-''`G " a C M � ,m' .,.<D' ^
0.' r rt to " -.:* G �.-•ro ro 9 "., ,-j rn° rD w . - ro n w,. w ro K K c,- y '.Ty _ " rt'0 '� rri
m ['0V ro0OK? .r' �y,wr° aa o , u, RP'.n " � roo ° �"5w5' n " R'a7' E �'•oy `° � .wiaz�a�'q 3x
›. 13 e'" ro2 c° io'S-.. £ ''' o- c ; o'.°„ ae5p 'ro £ og yoryw . 0— ° � A i "..".j
7Cb "+� " v a rn" . a a p a.a-° 2.0 ,w E 7,•"‹ R "r o•a, �'-y1 T O O
,ctnRC " -,ccca.i'ao °,oroa-= ^roaw 'C 5 DI•now0-an o w — En „to A�
•ra, Z •wio "•.r •orye .wbyeoz ° o,cyryad . R...5." . n0 wnw£ < 7, 5E.'� pp'O,, a z ;..�0
S.
ocr -w.. ,; aa'=ow .00 nV " A (o ❑ 0-ronCA °•row �. 3, r.• <c' ,. 5
�rf �roR7 " d a xp + sr
w a> a"a a 5;"r,.a_0 a° "II ° h'7o n
'v' AC a°.4, c £ o " mrco4 .:^ro .5'roFc7ow 40." 0 od wn0• .•rD ",v` ,a0 7,1' eA 3ZM
O 'Snp0 .-1=0p . �'y " " „ "' p Ir w ,,- " a•rroa4r' ro (° :± (° 0 9.11 , ., ym M o
C. ." ro p-o a o n,a p a a� w'w o c0 0 r" sc••y et F, y a ^roi ro -rr*'ocra y-rho a " n o o .oQ "1y,s
y Z a a o r rtyin_ " = w ""..wy '007 2 " " ° oc " 0:'g " " ."j.. ' ISD >•�, p : �"1 X
A MO ° 'OliU
" nno oD n e rororaN . r "'i 74 8 n.z--.5 0 n aw n,cam.. ;�n K o-`e 0,o.n''d 5't E 5 � E = ron0X0 r° . 0- a F.9, -� g. ?•O p v ,," y T p 1T'x . � �; a ^ Z r.2 p,�», (So E,' r.w 5 <•E'.(° w a �c w'�7 a 5 "' p.aM�-pa tliC�° m .aa �'a ❑•O � o ° n 0'r =o=w w 2 y.n " w y "'j 1M ro n n, CI3el
.' tn: a, xP� `^ .,n Otero f9�W S " O' Orn ai��ny oy� n ,nwB �O•O„ n `(7_HOR
Z0V' E71� Oew �on, orna.. '"' (otrr' r°D'n ".,£ _.o.roa cs,5 � Etg ' a.P R ° 3 3 ,..�1
'1 o.rca,a5. pa,w»o " ,.., 7?" roroww S c ,°�rop " ", aa, o et, 8 .: ., �, "/d
..'77=7' ro a cm " ,..1 ro n ,.,n 'a x O " " C ro ro O ^A rD rn E'C7
d`A n ...Oqr. �.,°..,�'. .., O n O n'O'O 't7 O,,ro m O p,�,...•roi'a ;�O 'art" �•ram° n G A.�' v, n P A >N
2. <�' 9 ?:£ no R0•' ,",--Qr4—° 5 r�'° roro$� c"D a'a ...a'na a,0 ° o , c '° ("c oaf ca.m � "0 • a'
e 4r”, ro o-•-� cr, - 721ySN' NOEH•95rDa S1. " _.wrt p �.� oQ "b � . CA n '-3a ...� [T1M2
°'ro d" ro ° " .E' ^.v...w -D " T`' " i,a' co ro o _.et,act ,»•r CD " 5'p O a a o F r", �a r S T•a,ry rt,a ca.?, „. m p m
A " O4 r° ,�,-•." w 9 o_ a O fli
mG a 'm4 .0;0 c xro -10 4. n �'o" <' !o O Da ..° p a "otiop--re <tu ia'cE " w•oa'° aro CJ� XIL 'I fJ)
D. E cr
'�'rt n Oe y a m ,•"p'ro n " �' y .' �`•'-••n7 �ro O'+ a y 0 ,...,'h raD.C, ..,rwn 'Al
"n<.74 p•h R.c. Z a R a O n
G.' ^.z° ww -cop woyr° "-• n"' " .. ro .a o " w n,� o ro ,.�roo " �.�e Z =.
to a'�_ $ n " 5 � $'S oawa�(ow », „6 .< a" p••� " C ...S 0 > o d
6.., rt rn•flro •Epv, 7a?w ^ p . ro •co ,;1 '° inwa' �+ ?, a ro �� o �' o ..00CC .)».�er
Azm P.ro, "°» 7 wnp o_a+ oa °•o� y 5•ro •r ro .- a.yro " ar„ y " o xrtm ."L!
n� ^o'o _N oa w o
� ,'v� •� ao w °' � wn'°vw " .h " Q0a c 'L" oy'w ° w ° " w_•
'' �o [w •
roa" ° "-; 0 " 05 =£ � o5d � Yoc;" " ony � o �'Z oo "D a rn
54'-4 ° C O.a.. — .„) a i° S»" n p � S B o rn o a ti n F ...4 ili o " O ",a trl V Z tD
n "-'0 �_'� =L '5 ao, °*°0 E'" a7y 'F'•" "Al �-w=F'< ar„ £ p o n �v c�, N o �.o o ^n Vim . �,
�ini'00 a'Sy o'r%D a �'S5•-^ E. o n ...y �a"c o' .o' o'o 4.aw zn.rt'a, Q .,, Oeg2° 9. cro � .. ..7� o