St Pierre, Lavinia Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
/Or 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.
Town
Dist. No Count Albany Villagt lb��y
�-D or City (If city,give street address)
Name of deceased 1i`�K-4-r�,� - -- " 'k.
Single, married, widowed, i, -S-
Se Color 4AL— or divorced (write the word)...... . .. ....Date of 19u,/
Age .n Years•.•.3..........,..11'lonths .3' -)--Da s Birthplace.v.:V ..I..... r..e14,.e--LQ. l•.,
Cause f Death
Certificate was signed by ?Y4 `..
Address .• .. M.
. .. ... ... .... . ...... ...
Place of Burial (or Removal .. .. l' /
(If body is to be temporarily held 11 in spa e ter) / N.
Cemetery Date of Burial S 19. .'
(If body is to be temporarily held, fill in space 1 r)
The Certificate of Death containing the above stated particulars, having been pres ted to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have accepted the sam r registration, have recorded it in my Local Record with the above stated Registered
Number, d the b i hereo I HEREBY GRANT A PERMIT
to . .., _
(Name) ddress)
th .. to hold temporarily d Gar. the body.
(tin a e personnaving charg, f corpse) ,, (Inter,remove,or of•, •v e dis')(t1e�1 tate how])
Dated 19. / `'. (Signed) .i-- 1 -'\�
Local -gistrar �) aT
This Permit is su cient for the Removal (and Interment or Crema ion) of a body to any part of the State (s ect to IoE
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
t".j'CI ."C, O w '.'w •N V, to a n o 'o p O p n p ', °..d ., .n w ', C_• n CY a• ,.,... .. CO3o 0 n, .1po'° cue'Zn04'Co-. .Q•o ..,..,4x r",,-, ° nn °•nni 0.p ° .5 .t ° 0p..I ^p•r. c
...z4, ag ;ic• •2'e••o a.RO+ ° °.y yam. w xn n O•04cm *6.i" ' A 5.�•--'°, 'Gro E'0 o ^ M o°,� >n "L*J n at 7 m
xi w 9 w -I a•a a.a•Gro _ '" •.. mN ! ii
, ryq ....+p rp . ro m p AN "80,w'50 �s°w9,,,�n , zfl
.° 7,.o,w•, a�� � � �z� wpv° y ►• :a • o' n 0 ro y o n w • 1,...'.a h Pi
ro ,S 5au, w n ,Nti . a^ n 'o x i'17 _ ,y'0 �' Pi
• oa2aE0 ,..°- ro —4.2, ^By �0 r, nwo ° *3oG°a•.in � ,..i x 0-°:< ° , ° � e, 0,q cZHCa IS El
0H n n 0m < .. 5 (:-.•ram _ o
tb �o z a• � �w n � Jt••w=5 w •e o ° w• ' *oro .!`" a n n -1 ,.�,.w ao iD n � H °3. ao `�X
..En n .... -.G gt.5,-n fD ro S .-n . ,...Cr H6 rt o w 0 n yW P ,,, o n w w ro y•..,K p 0-;4 g K'C ��417.
h 0m Aggc,•< �° nnaK ° w n 4. g, �• -=- a ' Wn2g5w .-,gar-m oQ .,. •t.00CA0 ��
° >p p aq ° a•ry n Pc,. a—°' -1 o 41 m m � n M F o 0-4 a 0. w a'E o 2 c'P'0 N'° • A K 2 x...4 3z
'q 0+ v,''O C •, .nynC "', a..w�..a �" Gnw ^' •:± O .+ .1 .r.0 .:, w ° 0 KA
o7Ca . n a ° ..n ° '+ � a�•a ° ate 8 �-�< ~ .. o0-o•� .°, H oaYo �y
a a w ,. -+ nn• c. C.. — oro ...,naL w �a pynmow ° nt. wC •w . to g A
q•'=tw G o xar''' .n,a 0.a'-.0 w o .K' p o w°'n ID CD Cf$ J�.,�•cno a•cn w 1 R•� r4 ! N $.0 96 <B.R x m Vii"s7
P.�a4 "-6*a0q Er,.-,.
O o f. i ° c.O 0. ....p •N 0 .4'» ,O a.•nt w .-w m a• �„n C.w.,.....° W 41 -/ K 0 rii0 M
g 1.12,•-] co
n 0 p 'I Z.'0 o � °.'� " m •v, .+c..-, • p W. w �•O •, a..,n a.A' n n '' F'D ,4 .n•so cog - 0'^ "' `�' M
�' a° ° o 0 'ro o ° k " o Mn ° � ^nn o nt7 ,
px wn ° •, n'b ° ° N.n ° pr k '' f'° n ', y Snrn „rC''""'p-nin• ,nY° pti it � H F >' M
0.� , 0a -. .'0 t ° w ww - ro - nat., ., O - ., a... -, K .. Er so p fe - try
mm
.'°i .�03 °� '^w� � � O, o n, aa' Qc cm av° � °o.nwoCD ,-, c�aa.c°D•°dw '1 “ i-a 4 'HPF, B i ��'p-1
6 0 CA ,-.'w'c S . 2 pro " 0='3 • ' a.n P,-1' •"° .'""—.'c n' w`°' � f•'4,tV .--• < < ..... ;, Z,.T,O
0 H S. a'a?,r°a °.„, a.a g ° 5ff.n m7 ., 0•° n 0 n ° °•� 0-C. '+-ca•w R •° ; a' 'TJ .,
"' 0 z w o N ti'.w.''1 n ° 5 , N`<Wp S'n O .n�. O co w..w. ^J ° o ° n „ y 5 .w.a 0 `-NMf A ., W 0
V 0 H G. 0,w 0 < .w„S,,, O a.w° n O ,nt Ls*,y �.n .., 'n w �•O y`G o 0 ,,,ro n 0 "r.�' A O 1° __ ._ '�.
R,zl s p. n n a'�a°c w a P ..n o .1 "' a P a'"' n n w w .d �m-•0 «n E .°•,,fD ° o•o ~ a co o a t 0.t' g F. w w w "A""JD
o Cif a°° x y H n w a.M1�.�° o 3 n " y'0 o rs o " y c.0 ° n °..acro .w, ° p-w En .. art o^ i. rrix"fl
2 2 5'n °•O S'NP *n W ..."• 4 30 ..o o .. < v+ n n ,• P-w a° in • 2. •o n ��{ vri V. o 0 �y.-im
4J �.1N n =i7-:al " �o '' un, c7Daapro •'c, a; ''=',-. o Na'c7Sn� � N.-n°DWOryi5,R �0-""t ..Ctrl� 0 X nril
O n ...(n 3 w -, n cn .n in 0' n O .-..7 Z O O m /r
CD •, •-• n •.....•."Y-1 0 m.„ n CD 0 'CI'd w . a..,."+ p N"'t a:.n r.n .n., G Cr a."A a A
"It�i'1� a � n o rD �n .w^.d? ' d ° a n � xa �. � a� a � o a n -, o p, a ,, 0 o:
n °'...,,m ° 'w' '+ off a m ti c � n a.E a o-t til C..a s 5..ai d O
0a0w 'CoiwK1C�-a4,v '��, e,.ao ° �, °°q roonaw ° r ° g.;PDn co � cn t'<°/0a,awHii Dl aHp�r, 4 �ZZ
0 6 t..;• N o ,,, o, o w 0°='b ° ° a. ,..,°5.O.�-ns '� o " ° a'n p< CD o �' o a n til A.HTp'
til
« K gWNWE. .°.-[°Dgw-twmT. W 0.b �•n ,-., 0 N.° G �,' 'O ~"p"+cwi, C .�+,'"".y [`nDMO,.at 000a A
..^".', 0 w •,. n 22 ?
jiifl
ei,n ° " n .° ., w_. a. En -t ., .w ° n �- a" w w ,h0 7• n
0 O�� 5.---,- w ^',1::6". cio y c P 0.P ."*;n,.'S a:y •Na c aORMO W z o '.o o;, ^ G 0
a• ,0... a co—on ' rt� m -5 i7)*54,e •-1 n .;T .=CD 0 5.0°9 ° a 7 n p 8" n O (O.� p O v 1,7o.'t.; O