Robinson, Rhoda Form VS, 61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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. /7 /
n J Tiaws
Dist. No (r C" County f� 4.r1 .... Vil] ge..
�or City (If city,give street addre )
Name of deceased e. G
Single, married, wed, ` WI'-
Sex.: . .Color.( or di-arced (write the word) 61-' -e-, Date of Pe..th •j a 7 — 19��
Age / Years... / Months /. ... .Days Birthplace.....•. �-•'-�L y
Cause of Death . . . /�' `•
Certificate was signed .... -'�" ' �' �'�� M.D.
Address
Place of Burial (or Remo •al) ,,��.��i�� ,-.t..r4 /`�C
(If body is to be temporari] d, 1 I pac y
Cemetery �� /- Date of Burial. 3.42 19/2'
(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 a same f registration, have recorded it in my Local Record with the above stated Registeredte
� -F�B Number, and the basis 0Y GRANT A PER�Cf'f`I,I�T. 1.� /ar��'
to /....( {� �, s)
the to hold temporarily and... d`r�l/ .� the body.
(U ertaker or person having charge copse) to ova,or otherese Ms, o t )
Dated . .tom 19 (Signed)
Local Registrar
Thi ; ermit 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.
c•'H•d aooco.w5..4 ..�C •n� 0o.0. 000n riot"o �'z' .-, . too .1 < oa-5,p., '»,g• Grtycn •...-.
p ,TK " -!,a " cr° q•n �<o4C ?,�o y� R•»,° -Oioawnoga: rrnv, "O --O• a�a� ro m� M
, >3 RY " O O4 rip 47.r°ng ? nr.0 n "'r rip ripE O '° 0 rorc ° J < nooQ rt
° a.�• w •, O wweO,C 7•t9e a'aQ rim •�o" " tn •'r`, 4a.'0 w'" o ° g „",r v:CAp `< j D'� 7 m Z
`2'4 1 o. `C ro a-g' O a•C ro .. •s A (n N n G. - m•" cr 0."... F. A m O rt CAE MI`0 m p m M
�r�.W N m a'O �.p ro ° Oaf m '•� �?+ .Thl n �'o g'�O W^- w ° •t "OQ A ^'000, A3"O ° y•."'..w"iy a.W •pe XI 9 R M. .o.. 0
��1::� . E.nrF'. " 2 ° ;� � yw � o e � < r°oAp N� ° vco 0 � aea � ,-,-- o °ba":nM x^'�v� .e
ti od ° aorp ° aN w -c wg ww " a a .ems ° VA
1 .<•- .i '-." rn .ne° 5t O.nro � ro0 n ornrrrt .rou, 000 < 0 .d A to
a " g w ,,, B r, La. *�0170�° ° ,.� a•wa.w < a •, ° .3 om x ox..1Ga LT1
2 C9 Z A`�a•io �5 Sb ==0 Fir o a w v *oro" z.,w"o A N= -- v•d a_ o °`•< �o n g ►1 w o PO
R. ! C n y o OQ " m �T-7•,. •..,•C•, a•c g w FL' MI
n �'+C CA " z 1r�C ° r ° " 7wrap � b " yn ° pc w ° r. W * rip Rwo " y '.ro N rtr .<LT
O , m ° 0 •-•0 0 0.� N° o.o rn y Zm " w•A.4 C'' A p ° -SR, _ ° °, " 0- G' C, m °r Z�� 32
,p•m - 09 C .-t rip w a.,.,C O °'a'rt w •, 0" a.< , ...-t �-O 9" 9 04 R ae 4 *
•t O. w'ro 0 ., w m CD " a a a a•C.0"C (.�_. •E. °r' Cre, " " ° ^7 0 ° 0 m r.r�"
oC " "wca.aa.o .,zfDv'... ,C�, ",°„aw o 5 rn'r0How4:nr, �a 0'0wa •0 -. CA �*. wgg Apz V)
�•p�.0 O w'w-fI.ry - ---o w ro`�o o X'5 Crti a.° A rt 0-C 5..-r"o a.N w ?;�.� w C N e Q G3<m m. a) 171
$.;��e � '"� a°"° �E o ^ " � a C° f"e ;^rho �•�o°� �a -1'aa.:1 0 ^Z go'- 0 n c 7•r°o »0..
° m:.M �.c'" I'll o rr..: • M0
p "10M r5- $6, " <-"5 co Crv" " m y '-'crn" W.nm- wro'O _•-, 0---na.w0 �7n., rno ...1 'n.Ku)6g .°ni '" r>�Z�M1
Q.I a)rip ,C0. O n,c, •.3' a p''•0 ° .'3'0 0 " 0 J•rD m y vi .-h'3�n fD ...rD y• " n FY r /r
liz p•• " a'- •'w'O-'.40 w.wk ".0 " • •oo ° 0g1"°o o -' nro a." ° K N a- n re
6 0 ° . " to5-o, „, `"° ngg. -•2o =m - o »,mo ; ".n.»,.a,or°,0sf mtr1. p -a��-i-». B 0 .0
`. M2 "•'.0•wr", r°. nron ° Bn 'n ° OQ0 �00 Krow gn ,+� a rao f 2, p-c t. 0a E Cr I 4. Q -
•o � ri re wa _ ° •, o o tYmrM�mto La ,r w �.O .1 .°.,rt r"p 7 S`. .R a.0 - rip •" i'^r.o a, w " u w ° a np ti .. 5i•• • z rrp e o .o a 0..-«w ° -wi rip w g a -. ro o 0 ° .re-.•?'�,-••.+Z < C ...~ a 2 o
m ,-1n..• 5a,,w°aa-ya•a = 0a-c..„ •o ° ow aaac e ° " 7 �;*g � a'a• "0 f/�rA�+�p ' wa.�o y•�Nrp ° 0'� <'� o •+ O ••,�. � w '"rsoa � S � � y � •w.�' O n •mi •�i �W0
b11'",' ng ° g'� ' EaP0 `4", rt � .r7a' n 0.ro0•NO6•yvn'�s •Ci � "p 'L=0..r. g '�q+1••1O — il il 21i..r70
rt`11x5 ° a•PDnro C ,.ip " g aro-"II'rowuw, o-a' ^ '. ° �° r"pa.a' � o m m iE.o -
° ls7�.pOQ •�p- " ..a.p ° 0 0 y'C o �• " w <'C7 " , 0- a•0'ro ', p•m w m .. o M 7"'V
�+ w w a. o .-.° 5 ° n n ° o r„ •, w w p w• `< ro ° A. m .'ti O �[°
'� 7r.Z'rt �•° .7.O w.'"'n .ri r•..,^, C`S OO .". < O ° ° O ''••�.rC o a• O •, O y am * o 1v��- M
* co 0- n 0' a w =° -in, a'_.w '� .." " a•w'w • a a.ro < S.p r s," •, `� r*..,Cr• ''' L' 0 "A 14111 4 M
pz
0 .gym ° " ..NM.*=.4.-Ifap 0 (ro"D 0 u' o•roroa-C �' A O �y� nw '�p0" 5••°.'coo " C0.Dm� a•4tip•� r. '�'�N
3 <m g �' n ° 3 �Nw_�° " og '° o ; s❑ E.a-42.� 9n ° g c ° " •"a.Ec5 -oa &' C1X0
�.sy h7E ,°. a'..,el> = 7• ,i'g0 �y' yO E =.," R ° faD �,w ., .w '+° 0 4.0� 0°ro rn a f/1 n- -it .:I
omC'� ° ° row o" wrro �=" `-; y o oa •-+ " o aaa 4 goy ° ° a H m gm MM2
m pL: " woa �° °=aq ° w gry ❑ �'7ov ��Ogw ° rni ° n � °'3 � 5 <a ;ennwyrr *�� '' �.�
a m °� °w "- ,'...° 5'0 °p= •0) S'"1; ;;: 0•" ° a-•-'a- -1y.5roa ° A •c c.. Z
o gr+< • 9 ° yo ° " ." " woE n ° 7..x° "ct , y' ° 4, wrpg ° wo_ � 0 rIImwr Vi
a .. .0 C r"i -0 .," a° r°i ?.r"p y Z C..rop to n C•, 0 rn C c "'�ro 5.~'°' rwn < .+ "ti G At a.ti n on •a ti 03 1�.�1r.A.L�
rrp, Et ru... rS. =• 5.
° O ° frG.a.p5i (D0 rip ^•.�O 21 A' �ro N p,W r°p-�.0 a." 0 n C o "0^.p ,'O �' zpy�i+0 /v`_
N m2R . -, ..,5 ... , ° y'^° g Oka•p� rr =; •T, * a.,-, C rtdG.. <, -, rn �^ a o"T : c Z1
m po w ° . . w ..,^0 5°; °,� •< ° rn o a• M w y o a' xrt m 3• _: C)
.o..o 0 C .. a;'w .p " w_. _.a.eto , " _won _ o.•, w F1°
70m cc.' r rip ?' ,°, row E. n y p C 'd » ° n o Cn m
M,`nrt ° CT... O ', `3 g 5E.0 ° oro r. E 0a,-8 •1 O n N ° O r, /...° r m "•.< Lt1 rt y .- M
1 ^�A ! ° a 0 a•�• y 0' rD C r'7 ° 0 M't ° ° y 0. •� p°j v°i O it •t n C CT'.
0 fn rT".+ ° `3'U �0 z �'j tp
a0a .•.,C� iA, �^' 0 " cicrm '° nw `. w�'° a a: , ga:0 Ma.,,'n0-c, �°, ° = o °n RpG 0
4�yo x7' 'R r°i C•cap 0' y°a o n .y �W o'Y.p Cr0 a �Zr"p ° " o m O CO �� iii
`.. 3 n OQ r °OQ a 0•rn `< ••, ° .., .w"'° 0 0 OQ '< •+ o a.0 w r w a•r.,-I = a•n p v R p•