Centerbar, Alice Yj
Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
5 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 URABLE BLACK INK. Re ' d No..._._._..--_...._.-
�,/[te!r •
T..?� Count 67Vi g .e.a.,.`9... „Yr
Dist. No ..
`��^ G �, •.• (If city,give street address)
Name deceased./!/.'140/ • ..
Single, married, widowed, 1
g
Sex ..... Color...Fr. . or divorced (write the word) Date ath •M••
Age �Y• Years / ..Months t...( Days Birthplace ... .. .. ....
Cause of Death r
Certificate was signed - —M.D.
Address
... .. .. .. .... .. . .. . ... .. ... Zit Place of Bur'. (or Remov •• ••• •••Z
(If body is to`!@ perarily hel in�a ace/ a 7 1oeiJ
Cemetery ,..,. •� • •• Date of Buri
(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
Numb , and on the HEREBY GRANT A PERMI ,vrive —
4. y
t0 .. (Address)
(Name) the body.
the to hold temporarily and
U rtak r o erso ha ing charge o c se) (Inter,remov ,o wise disc o tate how])
Dat .. ... 19. (Signed) .
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a bed to any part of the Sta (subject to local
cemetery or other regulations),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
-r ^t O f. 04 0 Jr .C 'J rD rD 'S n A
-zs• a '9�•0a.i+ " cP*�wwcmG-;;Sir°oS-oarm •a0~,"' -Ir, 5. '-'•All°, 'Ott co .-• t2 " °"Hn0 kA 74 YC Artw`� IT/
XI " w ..O .-t 0. 0• -Ci n •W•'"',.,,o'.-. !A N n p < -t v 0..., n n v, '+ n trl Oda 0 A
• '�7 '< O" O -, n fe .y :'o A,, -4,0 gr-.O W n- w r' n m w ro w p O W.,Y 0 rD !A� "p ID (D 1!7�""�'
00 ,Oy tJ) w n y C < • �y.. w ,N 00. z Crew SS n ,.,y^n o r.~ C ~Oq n �•� n ti �,o.W-, [1.0.V 0 x x; ', a a- 0.,, V
to▪ O XIT, w0.w .°+.O .nw0y • en2 ..ink 0. c0r.p'�.,.'.-.q0 •fo 00 w .y .t OC7'C.w c, ,:� r.e A Q
A�'C •0 - * roO o "., w -1 ° rote ren• R M ° r�-.,,, o < 0 • DT yr'n .+ N .StiiyO v
a -Cy "•1 51-1 -ni5Q »,pn' 0 `z0-clroa w550 *a' r' o0,,t' r"+ < 0 �.,_Q:0.5 .R.nO,p ?• wM °r „C..0 7d
xd?'O .d n5 n � � wO ,+ nroO .^ *aOd❑v 5'„'.* v, 0.w ° G -n, r<. wvv,, 0 '11A ' 4!
n 45Ll1
�r+..r p• A nro2 'd`E C t4ib b 7, .., fD , n -4 .T4,►, :O,{4O.Gi • YA ",L1r��j
r"c ' Z' *c � ti 3 ro � nrvD • o wr° nwv y �n+w y n -, " co
• rs m wC n ° 0.n C ., n , Z.. C. • • oq w .rwt7 m .. . h3 •.<0
h �a 0 OQ ° O re an p.w .n+0 p v 0 rD �' .n' w n -Z v, A 0 O ....K n .nj �.0 E�.0.v, �, " n CI" Mtlf
a. C •, q g .+ ,d ry'H. w Co ... GL W n N Z
.0 G• �7 y''d C .n mnC w
• C ti M R•a'p n ro O -t n 0.A, Q'w• 0 a "w .N.5 °•rt n 5..*-- -i w S. "•i 0 z-g n
• 0 su . -Ct ta7w�. m ..*C ace... �G•e_y ,*,n„0.p> "' '. p,•.�° 0 0•••n''< .r 5' -S'.p.< .."" O0 .�O • 1.'4 pm]
' 0.70 O C �.F.,.-. b 0-,.-0 w (t 0 G''1 -1 .'t-.G•(p ad DSO'O•" v' N aa•" w `n° V,. <5t°a 0a• � 0S.0 C z A M C
q .'-5- A--
-. y n 5 n w • n 0 w 0•n N w
fs',b0 ..n0•°., • 0 °,MLIog0 (., . ':ry •,to-7.:0 •-"g.nenwp' rosd.5.geL "ri • a° v, g. RA �cr." 7 "''I7
p r1'0� re.,wy,C -t 7.7 0 [,o rye .�C. ^ v'„ v, ..a'7Z."'' w rs R' W a 0 t 0 :'• n A) ni 0"P-�»,7. .' m ..T�< � n ��
0 A O 'Y ro c00 nw n C 'O rs-i .. A C .. o• 'x0�
a.'T'x 0.-wi 0 6•v ,b rD o P= k .~ti. O-5'2 0 u, . -^.'n n 5: Fr N m'5'C -, K•D • n"i I .* 4 y• p ». f
e l'�0 �dQ O p'0 w �f* N n n w .-,w ro ° 5-O .' .t .10 n b 0.- 5 ° ti .T. m a " n Y 2 M
"+1".1 =•_ ."' is n "°* y '' .JK' ~n O d 5i 0 "` <•A c O o' A 0- '� , 0 , �"'] �'
rD ❑-rD n n 5 n n rn 0 . n n _
w , nA o5 , o w -cr o n '< n0 wo M - g
1.4
p ,• n'w C< p '1 o`n n 0- 00. aE1 wo °'Mm � w 5�w w 5 G�.�°'2 n>5.C'•n �.B �, cCRt�p p.r ir n o,"LO
,°-y o' npw' � � •�° �o'�w C•0 •0O -ni0 .°nn c � � v� r�'O:^ p�w �� m--'R '=e Via'" "++"0 '"' <, �n
:< O N oewwrD .� 0e. o n Ewa- -. pcm • w , * o o-0 .''A wy "j x e ,�x�
-1.-1M C•.- A, .,r0"*.. O ro O. A° . nth 0 _ � 'no
y w nwv o �C �i, A ZS"10 'f ni e
en ZS. nnCro6 Cc'.. 0 " 'n n -0t" A r~Dn £• ....0 o• n�c+ H 't 'eq v'ro 0.� ' Ar..- 04 n n
m,b00C p'�Q'MoR w 0• Q re 5 w P.n r •cY5 fbo p w p O`C+ '0'^'.� A p.w W O A T"' w ��� ^; w ►XjZrb
z2"' tDcoadw ::0 0 .. 5 $nn � co -, y <ro •, �•..-IF n°aacr 1. .+ o •
V• 0. w w -nn , . -s - ooA ., < yrsA •, �'w 0m `< ^ r* n 'io c
e trJs••�7• n Z. 0 -� 5 N °�' nN o aw'�= r�D 0 0 o e ,�'c p_•�5.,�, 4 s5. ,.•. ..,od"'] 4 �° 0 70 ° 4�M
r<. C,1. n �•� Cn ,„ fM '„O co 'd En
n:°'d�N c �' i�' rD v, , m Op.•t �•f° n MC R.} a'�r•, o • ' ���
4tl4 5 � n O a O'n .▪w ..p. re o -, ''0 �.�xrt 0 v o n 0 C 0- a "] ,7i + f°
< ,6- mug ro 0 .. ..,v, -C. O.9s'.y• ..rSD� ro� � 0��. 5 n rt 7 ur -, C .r n -, 5 � 0.• Oq O 0.E,p,« ..� G..M � �• 0 4 0
m •d'Op enw r�oo"'1'0 -wi_0 EL. 1c7". ^'donnas) -'t°, o,- n0.00". ,,0.."'a+•v'= ° eD •I-] „ y" a • • MLTI.'Z'
..Q L..,C. .rD n ° O p�'-•• O p F •�' n rD 'z A 5 v, •< '•i C p_0.p, i-?"y .- C. 9 .�'
0.E t"'E yrSOyO rro '-� wO '.•' ��y' a 5'p.0.-n .a'.'A J�'',C'� . O n•, OC3.7 - 'wig wA'- , yra nO „r
0 • O n O••, C 5''z "' w O n y Lam'o ,, ••� in• 0 ,.,5 rs 5 n �'q A cn • ,•1„�{7'"n H'J.
.« :;�0 w w tA ..Q'n n 0s." u''Z. W^.,c1 °n .."w+ O n, ° 5 .-, .0 5+- -o w ';,,' w n- '., 0'p- x M 4 cr
,•.. Orow0v, ]'C'.n .' C rD roO -' 0 ,c ., n ...,v' < n nnO AM
,�Q �.. teeny o ° �.ac5 ", p °' oap;aQMw ° w-;w�.� oa� Z.M0< Anae.kr 2•.? 0n
A QW p'M -^67:4-a'n w n O ;•=r.o •p' o ,e o•o Cam'ry " °'•n*°=Q-w n •0 0 c n °�C o de yam.'*; '�
O l0 w n w .n.., O'O .n rD .n.. << C fD v. a n •N re •.' 0•. <li) ,t H M Od w �..y
%•�'`.."xF fnD ct,' ,,..--0 (e �,n*O'V w 'g .•*£' 0.' .r--.0.,7• �N C 'qj~ ",- - .0 Pam' !3.-f w tws '�W'• :1• ~
co,
'�'c"c` . = X, � S� � nT4^ cN +.� 5w°-. :lrD ° fn, Gn.nwo 0000 VI"p2� " M
A =.,..,�'d w -.0:* 0rt.:0 w a w c-.w, 0.'n'< p'y E q;o 'C, p•.0*,d °��, y•o �.o o ro ,9 r 0
R[7"Oi. 5'reQOCQr rvW cm- En .]`ati0 rt �OQO' .5' aO Gw 'r�� O , nnOr�DOr<i v't Wpp LIP. 0 O
.. - ^'ApSrR '< -, .ram' Oa.""3'w4wc'.,,.1d0.r�D � .i. 'T1