Hutchinson, Ransona Form vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
to 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........____.....__
Town
Dist. No.`,�.‘ .7.county...,.---c-c.) Yil3ege
or C'fty If city,give street address)
Name of deceased.R r *- 0-v't'''Qi w .1.4 G� ,�rN� .. . ... .. .
-zu� Ingle, married, widowed,
Sex Color�r. divorced (write the word) Date of Death.. / .. ..':-'......191-
Age :IF.g. Years Mon 1 Days firth lace
Cause of Death
Certificate was signed by.... �1 :. I p. --- - . __ mirr
Address - ..� se. ........... .... .�-rL{r , 7v`�Y�
Place of Burial (or Removal)
(If body is to be temporarily held,fill in space later) ,...........4
y
Cemetery Date of Burial — 19�jf
(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
Number nd o the basis they f I HEREBY GRANT A PERMIT ,
tO (Na ) ss)
the to hold temporarily a the body.
nder er or personpaving charge of corpse) (Inter,r•0.v o rwis0 dispose of[state how])
Dated. - .. . 1..$-`". 19.4f (Signed).._ 7 . ,/ t •
Gismo Deal Registtrar
This Permit is sufficient for the Removal (and Interment or:Cre f tion) . a body to any part'of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, . whic. case a Transit Permit (VS No. 62) is required.
l"H cnen o � woon ro•, 0e ' yw -rent a p»Hin '.,^b '.c' o w w5.5 e � n ° CE " ." o- raO rara O'n n oc5•-.a -;�•� a�w D
,'j,' .t ?�'A.A C G a to .� w :Y.n n 0Q o n UQ G. .t l9 `f' O c a• '>a >C "� w
�.Y S fC 't o "J "'r A rAi. O'�••+n .� n ..� n ro f O •ro •O •t
2:: a.g.'9 ke 10 o•W r0s o.cv rn ��9.0 -. ronaco v,t.'b'n � e g•-, �^,,-� �^n vO�,. o � raa tom' vfi1 riri t"V OT" A 2
X I* Q ,05.0 rayoA) rna •*'$ mow O05'OV5O W�nNnn " n n °:.oV° `fir'.,...-rc.p,w ,Oy �Z$ " go. FL el
•+.V •t CD- 0 •n O V E •1 ao
"� �A anAw. Cw .1 yn' .CAH n r,a. co*T=.,. aA .co oO w .1 `+ 0 - 5 Gw G7l •A. .tea m 0
.°'."1YG En nro o .r w • n rna • • n w9 0 a- •Se °ems M 5" .ca
ti '.<.."I oa3 ''' sr oav nn i 0ono •:' n °,1 -rea .G2.:400roew ° o 'CX
a'-t n 3 .. r re v, ,n "J_ fp'O ° .w *o-o d 7. eo c'y. "' ,?. p• C 0 rr ra `J .n O ° U"�t1'f
2 G°'O w g ��'z'n a•° 8 A °m *o -w�a fD c P:,--4•�n '. •w a.fDo �`e a n "1 H In.° H'v'n My
O o 2'rA N _- 1" ,w."r9 5 w 7 -0 'd ..o n4 " a' ' y .= /�3
R_. ro•O a. `� C n v, A p wry m e n• , ,„»,`e rt a•ti ,. R'6 "I'.
Op %' ,,a•-` 5•atgraa.ge.N ,n A mAW'n-1. ~ • con ga*.S M''"g-4F,i.`^Tgrn. .v, r) m R nosy n •c • \ �y�
° 0 pG �•O a 0.o a,w+C O [a. 'w ;•,.;- �G rno 0'•On a•C `� O . . E 0•a,,Ot R.w�,0 ,�w 0 n •t 00 7"• ►7i 7.
m''C O .., . m rp n H a.`a a c.a.. a,P,• .p: ,•. ."„ 0°-q :'... O•' R "I 0 D yy O �"'I
'°e . c vNdaacc..o.o °,af9o-_• 0Cd ^;;mow a aoy �wow �anr„ aw°c •w a.iJ� '" E�3 �Owl
�0
� .nyx ., o ...f°, nron •0C`° nZ ° rygon0Zy ,.,...mm � oywfDO•£ < ., . Kw C7RO x
C Oa i--a...tnraa. nKarn0 ]' O •roR'u, RwO.ryna O0 <itr, m (/1.�
�O w N o _'Fig 0 w ,b O'"3 R w a ,..,
4 �SrpJ ....•O.� R O ",'4'r two a cr O rb -.4.a. 'n a"'01 ,�.r O.'-* ,wJ. ^•' y w n o-s ry Men ...'K7 ��+,tr.ti7°e e " V�
O a'nwO `+ S? Ogna'H n -s want
, Ce. 0 '+ P'in Dag'0 -rcr...-�a.wn = io �,+r0O r� Li 4CAa22. '2, !��
0 =zH c.E.`9a9, �t?a �r+. 0.7.. ° V k �.w5 ~" c. „Br) ° oc ,00ba-.".B0 � `x emay�p 0 ..• y a
R p.m0 N.A ° �V -rg °'Ov, 'In 5' ---28 ' 5i .°y ",ry noes a 4,-- as° wo? ril :rIT» B 2 .c,-1
"• �`=E e p o o7,' CI °y r•n •*•� ray w o a +, m G b � A, --,1 Er N,w irE-� �s(ry •o a rs. • - P. z'.M-iO
,r fA '.5 as �° fDcr.w rt.w, 0.°a n < �' row 00y O.k .r•"•y'.-i 0,.e � e = rr..r fir.R:�..VC 'e _-- LA ' z
• ,9. aa.?�m w0'2 -.T, H0 a4. . A•ew EL-, , ac• °. W,yw•.oNH e, wiG rn', . . 9N?•w.,'P A71.'710K •ni •° ›.
4C • . OC6r v, p'ryp, no "+ ro5••rron •ra0' u, 00c..oaw m O a ryPZ
"a1 •• n 0'.-.S C 0 a.w o .-r r-n0.7�S n CD 0 w w o-t..- 0 ». o rno "" C.w r :� y �.r
Yoo =- - • o.a OVA" � w -,----a a -0"2 5' R N <t7 0 n. n n �°? o o'c+ ry 99 Q'a ,O. :n .► a- ill 2 00
yy a o a ° nn „ e -r wC�wia � era �ya� el « .:40 �M
�raxo . a " at.—. oo + of0f° o .."rnac o n o 1-] ra a.0 - ro v�0 . o'z o'd x'e o a w''-'5.ay g ary'o ° a r°y5;V,�'w 4? c•rro o o �, °0 >MTAO • • .t7 N ~• . y. . +n N N en N b 0, +OA' Cri g'"t P% ° O rDC n fryn :li a . . 0• f /"yr
"� ono rays �^' ry . � ^fDi � Oa .s5rl> c. .. a_ n9, n" aE•G.5 O : « 040
"C. ym .man G o,-'y - an' y O �.� 2 n raa -,..o n .w .r ra r. oro4 one m ~ Vl O .ja .r,
�•a dry .rai n n-M CD a,., � �.�� •;-i my '� � A C a � A�,rn, G •y^.r.O T.°,o ry e y rt M p � M Z`2i
PI O n w b n y ,"d°° w n =""' "y a s •e n c °.?;w H►�+ m � a err
C. �' nnv, o - -1 - • E. '° o.."'-t Y•no " ° pryc ��t�n � nw°aa'CafD 0.'�».a'" �"1.
O D 5� OO noa. •.. .y an .... ^-"`,0 w0 "� ,..rw0_ OCry". "=,re n6"
w n Rwywv ..N rPn Op`1 ,Or v a G •gin ro ^mEwC ln90on t'° 26P 0n
Hets rn *0 a.p,5. •^•-P • ,� w ao to .p.,'�i �'. 91 Xi
t‘
O p ;"cyn ..'^"� O.0 n n0 � � mm � •Oirj''Z •°ib � '•'� x"� .+
co
2 OP . p,,,..52.0 A) '*.a.� a w f4 • ..; -•'.,•�. • •G a.�'p C y SN,`O °CD ^� 0 _,` 0
F.tel aro?'.•boa ? noagw5'u'o ° :;'� '=r°�op7'°av << ` o$.n'w4w �».-ni � a.n� a•` 1p�