St Pierre, Baby Ferm VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERTIFI OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
• Timm
Dist. No...56O1....County Wa.X'reXl VPINik Gloms..F'a1ls.e...New...Y•ork
or City (If city,give street address)
Name of deceased BABY ST. .1---mia
Single, married, widowed,
Sex Male Coloi Yblit.0 or divorced (write the word)..StAgle Date of Death ,.2.6 r..•19..••43.
Age Sti.111.blarth. Months Days Birthplace.... lln oil .. 9 d*..Y't" .:—
Cause of-Deaath- - 4. . .,$.40. 13 7. ...&-:::§.11.QP.X.::A rettti. -I244Q.0.44Igt!..74.0VIPI
Certificate was signed by EAx:xy.•.DR•••P! M.D.
Address Cal✓3t5....t.allAa.•• VQYVI..XRx:k
Place of Burial (or Removal) TOM. Dr Q.3.iQ.pX}.okt :y
(If body is to be temporarili held,fill in space later)
Cemetery MIt.... 3211Q1A0.ue Date of Burial JU1? ... Q., 19.41..
(If body is to be temporarily held,till in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Jegistered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to r ,44.el...J.t....13o.1v1A G.1QX.e... 'e .1.83....No�!..:XQ
the Under t a keWame) Interim&n
to hold tempor and the body.
(Undertaker or person having charge of corpse) ter,remove,,; .th wise nose of Iota owl)
Dated......1TU.p.A...z tx1. 19..41. (Signed) '
Denu} Local Registrar
(and Permit is sufficient for the Removal and Interment or Cremation) of a Iody to any part the State (subject to -local
...m.ta}O ,w ..*1... t. n..ls+f.....1 vows...fiw.w.Y.I J. L.wwr�-� �.�5-� _•_ _._L!_L ____ _ T__- •. /otf,p fi ..•.� • �. . ..
E"P roowa.w •NN,Ccn o4rowoo � A r,o ( S nNwn4A a » p�ytn •....
A n ',] •T5 A n M,„, .`.MM '.7• A 'A '.Y'fl A O ... n 5' R' p p
o = nn C° A �<O4CE.A .:n �•w GSM° 04 W nO4a ryAN 00 "'S ›e. ' b� m ril
e S Ca rej , 00ro o•°•..1' n �'A CD O e ` ron AO A e
`• 23 °' Sw wCO+ � Fl." oq� •�On nA N ".." .4aroro w,n O A 54 N� "4 p-31 g z
'z�" � C.'y'.��'C7 a'C cne p•C'�y .., ^Ct '•MY �,'�•A�YA •S'A yN .'A3n iC'P.m.• io pAq• ..tOAA V1$ z`H mp' 0 0
x w ..o na awnAM° w o •.,, 5,ow�- ggo wAwwro ^o na w o s .g $. 2.
0VI '4 S< °'° n Aogntni co 0 0aM-4.a .1 A- 0 .....(0000 .. ..40 ri t-'•O A -. �O' Np .1 Sa M �i0v
2.1R�3 M N A p'..w< y ° n '" w ° N.n 'r A A n gc 0. �pn',r: .. c00.0N� F�1 r;.* Zi$ Z. - O
.M�►�••I� .k g.4 Afa° MO .Mj ° ° w „N..oAA • ff �No-Ai ° w MNg Cp ryo .7 l•, .C.'�Iki
n "4C.4 ry6Afs•„°n OP"Nn � -g50 *..A 'o'o.N < ° aANo0A < wN ..w 7o W V,
p n B .. B o p, �i" A'o o M iiwo o�A 5.3 0. . aw < 0 n A ° o e 7C a!1cI
"�' MClo ° ° ,A0 ° ' • � � T35 A�O
"+1m �'' nO A 5,0 °Z ntioryn'p-7.1„ 5.M°• (Ann. w1.16,, n ° C �+ O Or° „ .,
,.p o ° tsw�n1a --owAo ..A , Ae A C�' ... SAN •:N O « e .. g V'"17
gO A ;a... n at c• S a•-. P tl [s7
-%v`4m ..oa°•°, �� 0 » 4� cCo''g ';•...050o•Ax ^''ttP.'10 ^•ZA2 �w (1S, 0•D.M+K•.1 ..4 v' °°an Oy
aH$. O' wOn °POo p•,ynn N ..v..'" fu' wrc•0 +-Ia'''' p•.w. , �eCAn .fAo F.] 2e.' we / 2 - „Ztri
0 H A_, e+C O ... A ' A w.O 0 .�+° ° ry N N e m N •-.49 A '' •-•-7A N 5• n o. 4 se H F.
d.`T.A , n .-• = .- s,.I - '�a. oo M`= n00o 0�LI Ab �a- g5t)eM �...1 6e �a. 0 PPi.0
e � � 'Ypn ° p."'nAQ...0a- �wC'n <`• •AA o'`n �SJ `GN..w.w „ � � C6A L p"a'• ="0 ' c_ On
.:
H 5p ;a .Na. S •°, �a....a4 cd° �io » w• ° Ou4.r E•o w wl� N'AA N "i e n
'.'J r/�1j N N O "�. A •C r+•�n ° 11��A A ''� c�-..�•7 S''1. A N N 0 f! "!I p .ye • ` •.,_YrLw,'".y
q0 g 5.�+go • PT AN � P W° =° O, ry .Ae Sn rt.(•� .'' '"'•A 0-° n's ��•. "°'. g Np 0--n...r E ar. ° `14br—./w
. • ff ro ..O p,5•F• A A 1 p •d SSM MG .,., ,TA n aw n e
0 °• �•A w ' ..An «� w A A �j•, N A w On ..nfD A w0 0tri s Z pc
>IQ - , n ..a o rya .y NCY`^� �'�•A nih- <.0 n Y•..n A A°..•a CPC) no•t(n •a '* 7
7jjr�• .r A �'O ���w'aM °..ham ° n r, A C O N A A S F ° N < A fp e O 1-1
7.S g A W ..e o o nagE. o o ••* A •.=p o '+ O ►i 'ti b" L•.M
CA R' A C?3° w A n A ,.. ,+n n a A1'.w ° coo h" .7'O q 0.,;n `G..M C• 4; !'�., LT/al
'dh7�h�yllie� C n ..o NA.° PO'0 S'cfro A N (p AAro .:•y•-w • ��' �.co 50Q '� yp '�j/yy�
.• \P - ..t •OC •..... n .Y.N.•n e A N N Cr ••••(P* p.' n A n 0•co r.. .1j C 0+ - A ""
..•. AO (p o' 04n O . A .. oA ,y r. E A c t� ^ CAn9-0 .a o p d9 v I. .Ytt
..1 a.l'•. - ,n„ .�1•M N r+ N El,. n O o-N.• •� A A W n w '"�A o •r°•. f/4 M.p N A H M •.[ �M x
Ii : j
n o ..• aq .:• ry '" 500 ow ; c5.:-.0•.r.crA• Aa ,.j m om° m° OA P' •Ai °' v, `4 n c ° a2)-].-+ ;10" N .!►..ro .k. a.A A .A 9 a..-0- a —0 ^ o 0•N .., A .,. n n o p;...°. ..i p N A 2^+ p. p•.ti� m °' �S.1 pt-'� N ° •o••°'f° wt° ,AyWON.aQ {J� "�w. V�
° <oN �d �a a�p°.� N °• S'.r �ba�rA .+no N °° g c•° 5.•_° wAN ...n .^ n$' '_...'�wp" On
S w... -no d �•Aa-00_ � ga.A/ ° on w..c IIId4; L:II!tI
nt % p ;•0 "crS,3a�M p w w m ° o ^.g.0 •°,4 ^C < A * N M H».� we ° aA . �w m�o '�
. •••6 .S KA O-r• A �'"p'tl p 5•�'C O °•N w° YCYC• •t OM° a'•t�° O a• O N •y 'G !�G'�fe CR a.r
0 •m F O G a•.c. t7 C o'° A .A S.."1 ro n 1 w 0 A n n F ry w 0 •y 0 „a°, °•o [.I iv"1..'
'n0 �_'" �� °:o •'A+ a$�r'° '° nw `° w ;^< ° NQ <io Ma5'ovNNo �,00�O �� p�r. , 1
6.4
0. p0 ��w "ppR ° �; ° ? a2i �'wo o+o $ �z• •° n"° � oc o'c<° c 41
t=7... ° A ....W . AAw N 4 °n A :.:. mA ° 5•fi • n Oa5•w4w •G.° g ° aA w ,5;