Vilander, Marilla Form VS.6L 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. i 5$
Town o�
Dist. No...(.�aA./ County f.�!�/� Village t���it2.Bl..c7.L[ to
or City (If city,give street address)
Mime of deceased 7C?:// ee /..-.���.+G�at eAdPI
Single, married, widowed,
Sex. . eMa&olor.9M,[. 2Jor divorced (write the word) ,•,.Date of Death...1464 a.':/1.�11J../.4r9'•• .2r
Age 6.4' Years.... .......r Months .0 Days Birthplace... . `15/. --T•
Cause of Death . Cake...ra..dC't:i of-�Gd ed24G
Certificate was signed by C .✓c7.4.4 l oae...90/!2i 2,46 m.1 '..
Address /� 1� .4?-7-4i... �l...r •. ,[� ''- ,
Place of Burial (or Removal) 4.�..l4..7%r... .�C2etG�...�xi? -,0 Ail..Pr.7?.�ll...U,.c4ci....wr.
(If body Is to be tem Ayar[ly held�...e l ins ace later) 0
Cemetery .,,r/.t2Q�...L/ .. Date of Burial /ci? 194.
(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 he 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
Number, and on the basis the eof I HEREBY GRANT A PERMIT
to �°/ �-Ld'...' aii4v446
aR/ gel,"2,44heeet
ame) Address)
the to hold temporarily a tarb2Afili the body.
(Und rtak or person having charge of corpse) ( e ve,or otgvise e o je how])
Dated ,/.7 19..11. (Signed).... .,.
Local Re strar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any 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.
r iv o.c0w �w •N .N..V2Cn O •oD3Op n O " " mw " _
gx; � -, o+o'a,m6ro00n�'c "'g.° '"`^�,.� ro.:;•o.30,:iwr3� ao ,roaooz, d��� '; ,• 0
0 >5 O a.-• w O .", = w sy C Sp:rr> 50"0 .1 .'-8:4 2 n 3 'a*"o �'n 3 b ;ID ",O A OQ L'1
�•f av w' o B J 2
Lit R a'"' t R7 aw rD 5. N .V. .1 5 6 n ''eo rOn W 0 C •M °'a n N " ry:trD "C rri b..m � m
PS w p -, ap aw� ran •Will' o•.. p• yNn o ro 0, 0 a A' 0 .o .,.0 r ..0 02tr1 7 wore
A 'T1 `C o.0 '5 O "1re 00.
`C R .1 »'O 00,_.f-'p a',�?p �•M V�- wr .y , �'i7 ry,°, �•o.•a .t C.aw o '�z�p ypy O
R ."� N ry A_�- N �, N m .y ,+ n w aro n ti CD a 0�.� o O w .y •y a O �'C�.m Vyt i.a RI v
w"'n rP w C1.N 0 •+,w a N N np .1 C O,g.p 0.�.r. a.n. O C p rp ay-0: rn r.• 1r . Cv p v Y�.�
"'i'x g. n rD ° " O w rE 2 N N.1 ° rw•.N 0 p, n O,3 a• /�+
; ..ems• ° rn A aM `0-0 Q.N n " r *.w. N " .. ° .C.a 5 '•�••
m w•H a "a" g � CD c. 0r° y rnvo ° *�nda� Rr. nNporoewNobX 7CJ to tin
tow° N " r95--54" a'^° gA w oC .�`Dna.a-�cxx ap:e ° oF.4 •nm re0Hd5' V i7
O N .ny - r.C rt�'rD ,� �w r� ��ty ai n A 1.1
o w gm
n w N NN A w' v, y c�. rCF, 4.'Cf �'G T m XIII y
O C^ {p4y fD �G .'S•`.3 n a s a.-..- N 0 o N'Pe w 0•• a 0 O n w __ n ot -r0- �•0 I* R cl�'m1 �i
11
�p tl O a. q ° <'o z N Co 0,Do p �.x� p, -, coA " �.O a50 . 0 Nrp w O E o yO v, .T n K a z..•04
e c _ rroo 0 cy " ;v rn n r a�• a •=5 aw "' .w 3 .... . 0 3•�.--7 -,w ° 0 r] 0 0 'o m ..,.4
e fi'6 C m y°q o ron-in 2. Cr . o•o "» o,w �a ° v,'�N O w 7'n n N 0 a o0. .w _P.0 y ++ti tcS 5 Vi
~•O:+d ° .w_•y, •, ,..co 40 `Da.. .-0wno .1n ° o `"° A-om m....,p." xnaNw �w7nNtlxNa r' <g . w �rn Q
_ N rob , 'Son � anrsy °. .a a NC19 r C�� 'Tl
�0 P0 '' C. s o O °.," 2 .+ C O ran .-, rD 5.n.8.5.4-n a , a." w ^'0 rD r=N n Q'rD rD rw.. v.,'O" C�m„• M it c.e ro n Lt.
G HP„H a m w 0 x? O � rrD " ~ y N crro~ P.n x" w O .-, ".- D o•w rD �a �-•r.6, 9.4 n W < wo yZMpx2 qwy N7fo -b . � 'op",'� . Wok .". O-ro1F., ,- - get. .-.,-[Dy•5b " KO ° 1 .... 1 '"plH� ; N .4 Cl1
A �O N'Pa ° ab w EL
o v R- -n n o.m w _ o o a n .2. � a a� ti i . 6'� Ym a \
' * ql F�' N "'.T(D R n N '/ N n .".3 a•n ° m 7 "y (D O n rD ,� rn p,.p w p a- 'o :.•1 r+•.. t
"" r"�
.0 Ti j n-.owynf9on ° � r"D *n ° o aC � � aroa? 5n � � �a�� ^+� �] F n p. ��io
n to P. cg2.° ° ° " " rD a 5 ;° ?� °:° :: rrc ww -" ywa , c" p au a 7My
r •0::
.y " .+.rn rn 'ri M ? a by ." •a N �S''-' rD ro r v ° ....L•.» [!J G' ..� ."-1' . a Q.r.rw.N .y. w C w. N O N CD ^'r.r+� v. h.. n Ch
wHCvU//!1! aw0a �.Na 30 ._ ocn w oN °` ? R .0r* :.Q¢ =7017 V1f7
a0 tn a, < w�' t ..." a ' n°rroo �`Gig7-moo ,-r 0Nw ��ryN - ''''w, N wN * .f�� ''• "1'1 I154+ . q� t. 0M0y r.]Ar �..-.w O • N O'ro 0. O " rD O.', rD n "• rn O. re'cl,v y`� C N R7 n' N•" A O ro V /v
'�7• .7. rn 7,,y O �S a?Y O `+ .., � 7' `� 'D n f 0- .O..tD " •, 0. O a y A.C~ r' P Ai
T75i n C a ? ww CO as C Op D , w " rt p 7.7n. 0c �, ao o rD " g pp7� _0 rn �. 9 0'N rD ° w o-+. ,-." rDw o A [i7E�p�' NN w a O 'np n .' C OrD- ^, N C'C1 " rD 0q.a G"c7 Y `r Cf' "* N rr o '2.�
y xxw 6.'fe a•o nsw ..rn x ° c'J•< ° O O n .1 C V, N rn •1 0. a'w GR N `G0 ° CD 0 •,con O yM
* w X n Spa w =a' " ro x_,0 r. •1 -1 •o= 7 o O 5" ro 0 0 o a xi Z
p LT1•ri e n a _.pq r.° a•N rD N o'o .,a v ut N ...- x f D y ran o n 7'''�T. ry a+�, " 5•2,a• o s Y •�. m 3 X��J id
N " ''' ry •~w6; x" ry - A ---0.'d"7 C",. " p03 N " C A. p A ar_CA
"'�• `m py'�C n O 5 O"N W " Ort rD Z-.0 rro G.v, rw, ° a'G r "'r ..•""• p ,. °° n
,I.�[�1% D ° -•W.,,rDn .9 0- 7,•0 ° 0 v m o 7.3 rD o o.y" .w '*^ " o °vo-na ° d y•p'� N 0 ^':c n d.�2
O Rd."0. n" n " c' -w' rn " T" " N 0 .. r Ogr.^'r"D � .O � Oa•� � O 3.0v, nroa 1„4 ; 30
��7.
waOw < " wana �`° ww"bwi .ao ° H� va9w ° 2 ° xro � m ; x,,< -;eoaa �3/•-�• cv� ` z..
.,*.. �",.�„ m•CD ^nt n.•°'7O� w ° "��''w.7 .3`••aN .°.��."...:A o.0'Om " ° A.?"`�' wi '"'. "�''V a'r�J Q+rA Q.° H
O fil�< 3ON ° rD " .»•" 'i7 r, '' 0 " " " a; ° p'n . B rn y ° wpgO N VI • ,..1..,w V1�
.► ...g 0 w .w.. `R o o prD, O 7, a•c:St.; ry A N•0 ° 0 .°1 A, " A-C C N,:, '-••N N '^C rD .G1~041 a 1" ,j,m A a O
p- .-. o••y, O y" 3 CD O 7 pa P:0 cr lD w '.K .. .:7 I.g a co O " ° .`i
g m x� ar°o -o“ ° v „ aaw r"o 0 5. rn o o•ac. p co w w.*w Q 3 rxo �b a=o a o ° 0 Ho 5r.d ��
0 Q A " '-'s n- n .°+. O.5 `S,C °`C n y rD CD :'N �" n.N y" O `^ .'.'� .r ' X
o w °o v° ° a w :. x
"r,p C rr° n G".p.N '""'�' O•G ti n b .N+ 'a p rD "O rt .°1 fOn y rD n j v N �'�+ 4 [:�• ►' m
q O - -=.. - g P O••-•-I O•r�+ •d ol 't N *....'.F.W 'a-rw+N G nn 0'� =O r^, p .i 3 mop)
�*CiE �o
Q5." b �.a'� C1.0 N rD w 7'w ...,. .. a`n o.O " arr.0 N a.y� N �Y �,
a'rrn.°., . _•w ? caowH r a•eO 2 �� ''11N50°0 ° a.?w` oa5'w4wnOn ' n ° �S? fJ~ O S