Quinn, Mary Form VS.61. 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. /3./.-._
Town
Dist. No'0.— 0./ County k✓/ Viltage //I
///yyy��� .. . ..
(If city, ve street address)
Name of deceased '
Single, married, wido ed, -
Sex , ..Color.... r divorced (write the word Date of D th /S .1'r;
Age ; Years Months / Da s Birth lace.� '� •
C. use of eath . i„�z.=�t�i)• /.40 ..
Certificate was signed by M.D.
Address ,i '/. . 7yt -
Place of Burial r Removal) /!� _ 7,
(If body is to be to arily held,SII in space
Cemetery. . Date of Burial /e.�--- 19.$.
(If body is to be temporarily held,dl spa I er)
The Certificate of Death co taining the above stated particulars, having been presented to e, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have a pted the same for registration, have recorded it in my Local Record with the abb ve,stated
_ Registered
Numbs nd on the ba 's herd.f I BY GRANT A PERMIT � / G
to ( .4
the a to hold tempora ' and ress) the body.
( rta er r person haven charge op rpse) , e ove, er ' • os f[s1tatteho�w})
Dated ,/. 19��jC (Signed) M�
ocal Registrar
This Permit i sufficient for the Removal (and Interment or C em io o a o to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier,in whic case a ansit Permit (VS No. 62) is required.
t-'Hb
gfo• oa w '''w .7•' yp w c m o,E v w oa 0 m r.oO n °"tvo- " yCY w " < n o r a-0 '-
C,0 ..
o
•
.-,
C
° CK ; " oa �mmnp � o" c» a" w. �'w • n nn `rooa n , ° 0 ?;
r�r
•
LTlnC2 - -0 •robtin - .< PC< new D" e " atm '° Q c �`'�twm " o0. � o � if ' . 2
r � a A g,e-0c. o ,=.ti � -i l t '7 yo 7� % w p •" a P.w " n :'o•w w oT.0�'510 w,D- w nroyw CD w w o ,.0 " ow 0aZf, K0. 0d
to �� n y Ill � C m ,0 „o vi y 00. " nw °.n .+.� °nyn' C "OQ ti • ._�,p V p , ary „ 0
' w ° yw " n " ` C* 0pA M ti o .,•y..
T^ X na.v, , ». w y0 . •. mO "G...,< a < a n ,�0, m a. S�1 O v
•000 a° m o a.,,, " w g � O ran vm w a n '0-0 0.• .to 000" V, .C..aEn
o e �.a o [9 < ><m "<�..j xm" ma "'w a'� " �,, n ioo *anCa \ : .t� y0 ° � y C �G�. ; .....P "UITI
0c0 aB xn t -+ t o *o .tem •w a .w0tn � �n m , � -Q_En y ya °� F ,, . w °Nym "•Doy , < aa9 � ; - = �4
O . ry y237ro2 .d •iHnmaP , m w wet, <4wo ,y ,oe
m r am Ott �Z n a. 0.0 yn � .. i �•£ •ay ycoC)Ny
aQ .0 n a, 0.w n0 .team " . 4 y 0 -P O B r' ,o p5" a n.A O m ' n a aqZ. PC y
x aa = 0 , co ° ..", a w 'a XV : o' = „g 9." n , . .4 P.-.0" o. • a • c-" dw .0• ° as 'i, � a �
y yowany a .w5 A , 0 � nrri 0a cn0 C " "W a a. a.0 °,a c^ o•_ I.C,a 0-A, C
O ^na � � � ryo " , ge C•a0mHz ��5.-a'" ;� a.E =—',, - p " aa.ro a . 0 " � a. A, wn " a .'y0 "
" Q7 Oa _n• oDo7 fD , 'd n 0..O C y0 .' ? r ,,, : .. C 7. w Ili
7 " 7C. '< h7 -"9 D w O D"K7 a ,»n To .,o n W w- w W CO _; �.=w -o w : '1 •w^ tTi0 •, F
O0na,, t", rpc , r 0 . Oan , co . a." .-•= ty w m 0"J.n ..,"' y o Cr ., fa
O '-'0,...-1+...-1 wOO Cto2to ",� y w° w.mr wyr;'o " a.+Hawn' 6mi o 3 nti 46 C .nO ~
6 x Z p " D° " m Y-- T N� a. o wk �" r Mh R nnYCi nOO •i ► I
op
p rot 000yba.:" " 7 � ? W >O.R „°'3
19. � � " . R . _oc3a. . � a < s , ° •CIti .1trl i� „c' nan " o '. E.0 cr va0,0 •ovo2 Q.'a.a % A r, YEl E AC: O_
11 A • CTC y00'01n '. r.0 n0ntw + .Mff'n , w . m 0' " C OC 0.WM a ,- OZC. 0 aa " rn „ a= �af W •.. r"Z
0• to •w wa,.., na ..w t, ." C.r n a ' o "w."x` �,<5n LI 0 .... tl n o . cA.<. ab oa a a3 oa �mw" won ° n a y`e x� " w R .. . ;" z 40
n,
.,O a ..nn _.n a" " ' pv . n � C n 'j 0' to '7"" a r'X O
.4▪Q� < wOCwn , cn cqs. =- n wn'NP• a0 ,,,r0t ... = r
• •Tr 7--• o,^Wy O a•A ot 0 g ...,-, " n, n • mC°,,,by- aw0 a.w „�" 5 r o e. po .0w xP. cli na bb9ap " '+ a,a•mr nn 'ww '0c•wa Oc . 00a " . 0 - a T1 G \ rri2Ot,qp . mytmMa,a 0� $ann.00ry ko <b " ^ , , .a.ao w� " nC ^ * rtt:::
I � "�
eo (zti 2z . , aoawmx^' �< oo " < n p�, •ap r . .
0 :. o",,o _com )47
C� n w Ato T n o- -,a w _ " " a:y, " 5a 0.•0 < d 4 , Q CL., 0 0
ri'Ti A a •� y p -:IIa mb _ 7 n o n'o " x` 0 0 '.PO0 0 tora
° m " - •'^ " ,—- zoti'" rO " 5.:; G . vmo
A. <a o '` 0 t " o ° d " 5 a K t wpp, • d 0
E — . S m a.en " enna� •" ..•, 0 V'a�tTE w� S° wGn �� �•c7 �.y -I " n � " Wn0 � ' � O _a •A . a �a � �7MZ^� t �� � : n xa "y0d� " o �� � ; � � _.� .; " a ° o � � ncx 0 caw ^'C"a ` Z
4Oy < " m O ��b ,' Y= O y am y ; aa. � aoo n .
po m 0v . < 0 < w " .. x y I-.a. .m " nao. 0' " a 5•a.c. .-, • n. a.•i r' Oro , a- " s0:_ c.to G:10p-.2 r�" Z
c > . NGyO • 0" • "o '' w , w �pw W F�
R ' ." ° dan" mwOa 6'•r o PI:" W 0 " d 5'"° w711 . — n XAl40'
0 ma a On
< y � mn. at .' w �on3 p aar.ond •.> a .t"
tetiPO C < yNOOn0w „ N •n -tan, �
a : 7 noa' pa .wa.vnw .h wyA ?.< on0•,1 n.< > MT
A 0. om � oy - ° �'- 7 nv r ., w _ . 5=° ❑ � ,O O d
^+x,
rbZ .naa '" o o`< a•ed,< ro _,... na:a3 d o , »
Nm . " "D On " ..,O ? n p„,oo -,. oa ` t ,rn 0 aa y -F w • n A" '0 w x..to . �
O w n w " ".n w. a. 0 " o a"
' N n � ° " �" 0 '` s �rC:. ,,.. -,. m ,- nw "0 " = 50-•F`COaby >cr " " 0fv,•0O;l .p " C , LT1
",0t,
' o a.ahok o� < n n 0 ." n p :Is a N ry�p n t, a _" w p rt . a C7�Z c0
n O� -. �� a w o Ey Q� b ° -I y w '� a a:N C � � r ' °�a o a. b -,)- o IV
,, o 0.04 'Zw �.a a0ymwx r. " my
L.ri». Fo �a r' A H m?,eo tm .'I' :=1(? a 51 ,° �?-w oa.' w 9 0 a•° n g a.° o
1 a '�7