Kengel, Solomon Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Pr 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 alter the FILING and acceptance of a CORRECT AND COMPLETE CERTIF 'F�.OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. �7((��
��,, Town Q
Dist. No.5.� el/ County . ..i:i1•-_+L. Villa 4
(If city, give street address)
Name of deceased
tingle, married, widowed,
Sex-.'" Colo*^' ,r divorced (write the word) Date of D h...e�4l/ t/ 19 74-'
Age if Years Mont Days Birth ce
r
Cause of Death. ----
Certificate was signed . eve: ..... . . - C, M.D.
Address /``4-€'il _ -
Place of Burial (or ovals 7-f"'w"k ..
(If body is to be temper I^ eld,fill in e er)
Cemetery — Date of Burial 19
(If body is to be temporarily held, fill in ap later)
The Certificate of Death contains g the above stated particulars, having been presented to me, after careful exami-
nation, the s. e appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have accep !'d the same for r gi ation, r orded it in my L R rd with t abo a stated Registered
Number, a - o. 1 - basis HE RANT A PERMIT
to �..!. ....
N so
the j . to hold temporarily and e body.
(Un$.7, •r rsony'�v harge�9� orpse) et ler, e, r otherwi isno f eta
Dated G�2,�I ..(;/ 19 If (Signed) Cl
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (sub'ect to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
t•'Ho oow •*w •� EI•rr:ca oFrowoo n o ^ xroh w ^ < np p, .n- H •,.,
°nx. oil '' v0'p,o�eCR = P..3 _.ow»,» 0.w r�'» � CigwnaIaa° tio�''oo �p' y*")'M p `Vice? • 171
n.
•z5 a �"�eero 0, r:.1 0,4 Tw w0,o !.,,,n o� tea,,„ „,, ,'n` (1 0 r.•—O y'a�w'� y ce a ,^, acc, .< �lC Q'q•7 A Z
•"5' a. aCro .+ p' n 0,Nn e7 < w•y Ty�t-• n ° ro fD CA E V ro A 0
s 11 p to)rii w '4 °'C n O p'.a.wa R y "7 00 w. •OJ o ro O ...,y^n K fnf- Z •MM• n -.•-I ry O .-•O w•-13.ro V 'f 70 z M IQ '�� .9...
0
p "+..� 5.f ro co n !ae � °i p °� ti ~ faD ��N(°,'p w ° G A `° p nC '' •• rn S a�eVi p " "A
,1 o r° a o ay .. Al. *w
.•< r° .n ° � inro0 � ^ao n oo,y ^kp ...n.2 � ° o � < wo 41x CAcn
° a•O tea^ ^n '°+ �...o r'"i fDw °< » *�° dovAo ▪ aw < - ro0n •0 • • 0 •,_
C.. m B o tr o �e •+ o h"wO CAE
q O• 2 n _M fo n' E w w �t °,7 �.0 * '^v' C•e W '•, rt ''''- n ^ rtN.N _,.O r. n y p• CAWA Ira
'I rC y ,, .Z- GatrnoA ,, wo 3 ro -, to wP cm mro,.,. ' wN ,-' "'4rsQ.^ "' 1 "IroI .(1yM Cr1
• t" n oq x7gi a asno Zy �, pJ ,, on n fig w .v «, Crl
�, B A0 rtrt° .7 r° � n ., rno a 3 05- o^ nwo ° .,.. .,,I"o �+ Z'
.t d. <.�t n p •.� fD .' E 9 � n �',,.. C p �rn ,y � rtC Mw O M •
0 0 o a ro ^ ^ v c a », f, a ., 0 0 0 ~I
.0 o C ^ �,d7q c a 5.a o ° 5 r° cr . ' ro p O (1 nt owe 0 7 g .,, U]
O p w �' •, n 7G' y •V c o '^A j .7,o o vi ;; :. ^ p m p n �' w e p w :v'V� Oo.� B .Y A
'�``�' ^O xw"t •nt'R ati.^'O w r° O ?G'^ 0.�A o�° do ay w F no a Z—. O O Op'O„ M p ,PO�0
O» ._,� w-. ^ �, ao ^ 9 ° nsvor•.� cr°2.
el p, a. (9a(9 .. X p �. i• <cr� g PI 41
�'�O Tn w ,9"1, 0 "^ R ,C0ro �rt n ''* crryp C�^ "3 Ow -.•A� nc Trl �... .t •w.,^� "▪aEA4 ^ o 0[/j
O ►•1'...-1 A S�O - ° ro g ro ^ m "' p ° r9 " w n 11 y•O Q'§ p ,- ,5, •, -..e fD • r.j P. Uie C Z M
O.x7 o0e' ° o0'`:1, zy'ow`^° o wwX :.0.0o .^.: oo ^ co O•o° vro, f.: 0 - `� ,..in ya..4 n • , ,,,�
• mO mQQ .0.,°'ro .twrs'O 0, .-.nn J w F.; 0wn •'re ^ ^ 00 `' ^O o• ; M
▪ n.ttr7 ,� w ry � me ro ^ o B n+ 's rS° o °q a°-a'- b ° .Mo$ �� a a° n � °- F � rn
:��I . "'<�
d �a m ron r° n `yp �, ° n -zC .n• Pn' rs 0 IY • Ox0
• 0 rtw9 ,-. ,-, ,(^DN =-wrtYpSj �,o °',° .o•� oe �� TA we.:--, a',.4e�gno t l0 Z.-"2
yH < p'ya'oa a 8 ° _ �� ° •orn o c ° 7"0 .r."- „ F3• awRN•"sA p•w-^'n [!�Ar�..
O• � a' wY'• v.'.wi•y n O.7 (D `[pq �-^I O •n e,. p ._w. n O rt y .e n V. m "� O �' Q,. A '�rl O +t ti •tee
,aO m S• wpew mZw 0.° o n r° 3r a a cc .•o n O2 "cg �w am rA
.. '�i0 n 0.�Oq w- rtN ^s !y 0.NN w "� 7'D ^ O^ Qro " 0.w ., a. col trjPh n.
o a� T ;n r~ii {{f,�rt Y ° O rt'v n n �' C O •rt et a, C ro p, ^ rt n a.a C'n �.^ �D E. .. ;e • rt o o• ttl Z uU'
.122.... rt T s rt rc xt n-n-.-t 7•< ° p 0 * n C �'.= O c rt O n 0 °-R •- 0`� .t,4 O .•t b 0 3 O F n'i ttri
• to Cr n,cr w —rn ^ re T..•w rt rt., -, a w'r. p,'�y < ro et ..,Cr `C l=7 O
'od1+'n• 0 _ ^ "0 � � ❑ ood -,'o•o n wr, o n•c ,,.1 w ,.•T� ° r • - ►>ZCR
O n .t •OR 5';�..t rt�•., rt n y w m ro �' w . P.►..•t n •, r° n n p • V!
.� `M r° 7 n rn Art rt ,p COr° roro re rt C .»< rt w ° a a. r?•^ ° r"� r •II• re
'`1trl� °= nor5sCn .--oct ro ° rn ° '' ^ tea �'mn+ G •rn -I = f9 ^ o to d 0
! *. �o �•w.,'rn ^n ..x'KrnnroVo' rno ° 50• - •, At 0•p ..p �� ^ ° ?� ^bryoa~ � n "j• wp•� LI11712
ir p Op 'e ^ A)n *o a'41-0 we� .ao ° � o ;.4 ::..A• ° n,°o �- co , 0 y x� <w c o.c�0.H n��r 0 .�y
r�• y.ro .t n•O O- w O O.. m ° 7 a°1 ^'+° •-'.n ?'••Ct -I . •n O C...• . .t `.p'm 0 • ,.•o ,'.On Z
`0 6t"a _notion • , ^.^ woo nN a° w=t y' ° w ° .»wr° gao_ w "1.,.P U]
0 e . nC - W.N oaa " °••n . 00.. TC..0Sr° „•.^) O m 0a -, na0--00a4. ..". o MIIa A
w ".N w ^'n O in n S E.''n w O r° A'0 ° ., rt G R'17 h < .+,t n C p•'y P.r • O
uo w o ^ . o Vi ^ ry Z
o p. i � rSc � 0- --, ^O.a 0 =; � o °=°D � w rwrte F w rnnr� C �`^° �rTc c rc*° a.� �, O „d ��
R • zcr rLr va'� mow ' o'a " ° r� a. , 5 CD -,, 7 ° rt ° H-"?'r
• • .t ...° ?- n .0 ;..p•p•O rt O 7`t °.' o H j'n *. n •y .n.••, a m N ^ O 'n .=o•• pi
O ro O w r° w ..,tD .n- w-, a w bap--.+ w T y PZI
'..3."'.•. 7,-re . 7 r° ?r,ny C' N 3 � G o E b aa,'° 9 a•-ro;1 0 0 to 'o R' ° ,' ^ ^-`.o C�r1 o C°• trl
C X O O O ,mot•t3''N.a' tC O.0 A N 'J'rt-t n O '•7- E w Q, O r° .•t n c •r^y An'•p N.^ p N 0.ty L=1'O z ° t'+
a w 2.,.-`-.'p ....,.0. •°,0.O rn ,—r° 7w V.w.,, -•rt'< a w ••p ..1j LL O'0 ry 7 w r:•.'. r°.0, R m p' i0
ah7.O.. nn 3-4nP.Au0, °'H ?'�cti n ; `" .rngFrii ° 4%P•Wo tr' oL° ° rna ° W9 F`.T•