Normandin, Hubert Form TS.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 CERTIFICATIF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. 4Vir
Dist. No370,./ County.4 >
—Village 0.ii&t."--fri
Name of deceased or City (If city, give street add s)
• Single, married, widowed'
r
Se/Ode-Color. ' .or divorced (write the word) 7.,?.€.1 .-7-4/ Date olyeat 4/,,e 19
Age h 9 Years. Months. ,#.4e- D ys • !,:rthplace ... .. 4 ... . .......
Cause of Death ,c--(-0,
Certificate was sigt:elliy. .. . .. ... ....42.00.-3.....„7. M.D.
Address 4e.e-a-----0,. ....r::;•
Place of Burial af ;
b i mov 1 I... .1,
(If body is to .4ii,,Or -'Ce later)
Cemetery F -., - Date of Burial ari-/..... Z4 19.fir
(If body is to se tem orarily d,fill in space later)
The Certificate of Deathcontaining the above stated particulars, having been p esented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY Lilly,
I have ac dipted the s e for gistration, have recorded it in my LocaJcord with the above s ted Regis
Nu ,;idei and on th EREBY GRANT A PERM
% Zr.,0"---,.:-•
(Address)
the to hold temporaril the body.
( rtaker ore_r_.sicahaTing charge of sorpse) ..
( er c er ' e nose of[state how])
Dated. 194/,/ Nrigned) r"
Loc Registrar
is Permit is sufficient for the Removal (and Interment or Cremation) of a body to y 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.
I-►.]p U o w •'.,w �•�. .cn m C n O ro w O p n rp ^t C,ro •.t rn w •t < n a•wa "*.-j(/1 •��
O ., 0"� ., 2 C � n 0,•C o•, .4,...o ..,... 0- co p n 4 C•n n O C � .;p'� G p- 0 0
x, a e n .t E-p ..,�! •.,yo� wnnga •, `oyoo o Ya, >� '9.- w trl
O'>S n n <'Oaw ~toCwN2�G ,noo .2aacm •W`Y � n o .co B .no •, " per r � 2-!1 2
a.a'',,, ro tvn C c.1 w-iaa�-• cn 4q ...o co o ono pz ro w ro"� °3d w O ., a• a.w .t n •W p,'r.O ",tf Cr'+O W n.. w n w ,w. p ^,"..r'•, C. W 2 0 II, 0
A .T-w V1 S< 5.e ' n O,C rt w 'o CO:-•g-C ,_.c N...V rt n .1 cagy V, C •t A •' " �'0 p, ,V R K 0 v "+�
a• +fm triX n E.w C.y .°n0 ».w ,°7 p•.
~ . 0 'g cwno`•a0-•,�r•Q 0'a°'1 < 23 cro KC y r3 w to 5, ',_a io .O. , z
�►-]�y� O n o o , p w ro iv•, w D a p *a-q °ro 2:. tT1 C..p
R ,-4...,,,.1 .onga,.,,2a-oar Rn wg ,22 *s' s cp1� •, < o .Gnr, pocc < wp ;�
w Q,O �'•, '+ w n ,„ 5"n C K7 p •+, t d O V ,. ti O 'b
vi o o n 0-n •'f ]'w O P' A w < •, C n C''„S?± �^' „'"'„ n '•1' 0
PI OA 'z �m w n `-5w R ° C �,� •r°'C7 w,0 C n n c,' -,. '• cD n �Rt po OC �H �j.�••
�� (D r.II.+.,, M C 0.N•n to,o a.m µ�/'me 0 .-]n_to A o � ro to ,,, N n W..,, m•.",�', ro Q...1 Ov „,'0 N-... �r�
rrl
R r C w n tlQ 0.,o n L1.`t a,a to n `t. 4 Al__6' •C,' ln -' ° " .1.w r.n n .i rw pq .to n.> R R o N w a 2
R ,›'pl A. Og o on .n G,w..,n•.O ' nw .t n .tmO G.° '". w0 � o2M 0 ,- C '..,n ti ;Re 2.nOp
y''.0 <•~ C .t H rn co C ,, n w w C n W,•.. •.<w-. ,. n C,.t gt• •i w C 0 0 0 0 ■..
0 X!'o n5'cr� nro •, �, a�• a..o- ay .� .,,, n� �'w R H o0yo ' H
A cnm C w Non C a.w 0-o ,°..,° n G• ,. ,C n a..W C p v, 4 y O w '-" n w COO .w �_' "^ W a C/1
R•'rJw C o on w' ". °0-5'a=0 w n o n-"' ° ro A., G n 0 �u.o �x4 ° rr, w � 0 w � �N 4 O 570 Ow » g •
CI
0-24`< tr1 C pa 7, y p ., n v. 'c' .n r' Cr 0'"* ,••.o •at F w n w n C, n Cr'w O t i O R tt
,xi 0L, , n � O .n •, COn ,+ Zn nw , a . � w wnC � n .nv tw :!.� ); �OV1
C ••1,0•n,-•1 �nP:O 't Tp O cgo 2 c?o tam y cr"•, wn DP• wc`n'O .la. �a-wa a-I..+co0 H ,0•tK NA T w, i+
p �'co 0 0 '•o O o ti m C w ...:r n n Gam.,..n co •C. •, C 2 rt.]
�i w C .t ,C " w n ., 0-C n .t v. n CY in ,d A O O R r j R
A MO m °,G' cf 0 ° 0, " n --� n �.w p o °.rD '. n"4' , a° 0 p .0 ° 0=°.►1 .. 9 9• •<H R C'n n ., O �, " Vq na. O„ _
'd `�tri q..n_"-w w r' n b n o R -, "n o C q C.s aw d ,,,, p00 ,1,-,• cr a,a,pn,g 5.•t n B M. 0-' P. . * \ O
A xi ,+ C S.000 0 ,, ,, n a- w° , r5.,dw w n ,7,'� c ., P°a < 0"•w 4 a n :�O
0 v� w '�.C C a, n n 0,,-.w S'p> a"C ••s •p.'co co p ti n C a, M W• `< P-`C M rp w .�„ o" 0 tr1,,,, "..o 2 n 2
Al ►•3 CA.. 0 G.P'-.M C'v, c]. 0 '3-.M.n •, w •C.••o n o w ^J o w `. _ `+ o _., '�- 7,�, .•r.'4 - - ,s- ry�+=4 O N r C < w �.p' co 5.On9 c<o•`C 0°Q 'M p .., O y W c�"o y. R N y ^u' 0 f1 'S7"'1 p K ,'ni �,W O
o`n=o a.f.a.PDw w a = aw o 3 w 1•P�•a•t w 'e o v❑ o c - o coc - a.w.1 CD w 0 N 0 r fo tr7�,0 " ", 1 . �2IC
A., m n w Cl. ° O n C 0 n n C O `o"n w m <'b ^, py-p, f, N.a.�G•r) N c 0.. n i-ni. O °,, • H"0
R zz_ L3' •O 7-Fw_,•'*n .Ti-•,-,•.,C..< O O •, C n n G n' O R "0 '
A co R• n o- R w _.n •, n C'.. w •, •, p.r.,.•:=�.? 0 C1.'i7 C C''C a cn .1° `� Cr H 4 ill A 0 pa 0'< r'1 pj
0 n •Ct '-'� -,-,,-.v' ,, R 4.•t •,cr, n y v, v,' 7 n o 5;fP_.•n,A "0 co•, n .:n " O O .`mow 0 fD >Z Ul
2.'�IC<P g p= n O R 0-wj A'ccq •ntb CD CD co o* 0 �. n an.� 5 'ATO az(D 0 o a.� p, . 0 y,•� cii - 0�.y
<, ,C, C•2,v, C o-ti' ', O 2 n a. c. " C r. cr PQ •, m a to 0 y a _ • J V O
x -.0 w `e o �°Ti 4 o `-'04'o •w,=" -.a.o � o o'n uaa. = n d V;cac " r "0.�'' a, Cr a o- H— a��� R N CI Cr]2
C"cr. ••n , n0o.. w o .-� o a•a� •gin a�n •, 7, ° .; °< FL.— ti �•nba�n a. •„w0-2, O� "�2
rE r� �ApoNwpMo a �.� "new ° a� bar�o � =i� ° ow w_ng � � ° �oap {J) to
Xto I En
_ ^• O W p.-'. --c. p�b.n o y" '3••-f� .wt -",0 a,O 0 p 0 v •" 0 `�'�.C'Q o,o ".vw, aC •..,• 'CID .C�t p," G.C" .22 m A u' •` O 1M�7,
A 0,Co 't7 a-„, ° 72 a"-•p•,,•R•a,ri, 0 C. cm R"a o ,, w .'•'O p> n"..< p..nt ? --"4 G -•p C"',•,p .•G '�, 0 y ►A Ili
A A O SI •fl.•nt ,., �• ?.,.f, 0 �. .o p o aC o`G R.N �'rc * �'w .y (�D ro p,y p<, •n, ° v, X_co.b0. .I•0
0 A R 3 $" 0 'w PI, 0.0 .nM ..,- a- a- o _N •, 0 R. -'� 0 r. My•, 0-A, 7Z �. _ 0
%^g2g n N Y J n a'6 p'V a ., ."- a p 5b C >crC '71 t O On y•0O . w.p v .y wV� tt n 0P. '\ M
i C � oC. p'° yp-� c�o0`ea nc�o ..`tCO :, 0• 2p°, vn, On :1rb0 .rnw ,0..0 ob p7* 0 to
nO� C , o . , crr• o , , a •w c cn cr r.,•ou, on AG�
0 a-M Y.�-.'o w �..a.•y. C3.° N a n w C•••wi -:R C.• G v, p M a_,r, n v, N ;.O •, ^e"'�� tr1 �D.
.�'h0. C N w.W fD W'J n '"J v„�i'.n(1'`Q'� Pb :n v'7i, 'w^'On4 p �'W ° .nfZ.N o G.�•w ° w 'a.Y rv°,•n, '.O3 G.a 0 �A" , 0�'r�`/ ni
s