Fitch, James orm vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. 2.1-
�/�� own
Dist. No'•- O f County 1'7�'5(-44-e--1"..• Village t't94 .,�
reetd
/ City (If city,give stress)
L
Name of deceased i...(
Single, married, widowed,
S 2,604- Color or divorced (write the word) Date of D 19•��
Age Years.. onths _ ys 3/ i-rtyhlace.��' � 1 .. `�4=7.
Cause of Death c-..... ..... . F�'�C �' *^ r �r""�
Certificate was si ed�� �r M.D.
�"""'`�
Address
i
Place of Burial (or R oval)... .. t*"- tyler--444•-.64.44WK"
(If body is to be tempora hheeldd fill lice later) '/
Cemetery ( .74t-G.••• Date of Burial....Le 19.T y
(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, anc�p>p the basis t ere4f`--,Y H GRANT A PERMI'�y / Q,(., ��
to CCi�( fj' �1
ro(��'""�fAddress)
the to hold temporal.' nd.. ?I the body.
(U4u er or pen having charg f corpse) ,remove, oth se disoo ' state how])
Dated.... ' 19 (Signed) .
Local Registrar
This Perm t 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.
t'.,..3b 7,
O A, +_w g.,O•nm v,, ry O ' O."p.n n
r.p , ...0 ,�co
t ow , < n T o.o .w.. p
w y y
M
5•^.--,
2 ,1 „n C'o ? CD »<oq C ?n .'" A - n.On 7no ?2A aaocN' °,
op , O7 0noon 7•,• 7 K - w n a� p� m
. a ` 'O °' it�, rN n O ab w ez R ,n oJ El ` nZ •z w `eb c •c.0 yw ° -, g • CO ,, w 'q ca ; • o � Iwo mri '-'-o0 w
;V o aPi w"' ° JNnnry nO ° , n �Zn Ov n ,I.,0CA ,, (< 7O � np`< y gOD.•'SamdOc.., nnyco:'n0 ,OQn .. p ,7o,wo,V 'Y •i OQ 0QC4 W co pwr..co ", n c. w'a. , .y a» 0 0A' wa pen gGmz; °
g. a.. • , _ , . ,•OT ,• 0 < O rn en •. • XsH: y n n w s�PI1ijfl
0io C� ° - <N aw»w �a Z`•b , yn n : ? w 5rnnw " �.n.Twtf 4 y aqrD w M'0 ��7
mo w n ,on 0 n a.,«o? n n w•ccy -. on» nn , n G � �
no p ?- `' -.w<�•a w '' 2 amn 3a � .o, n' aAa'wm5. n. y , nn wo aw5 ° np ° ? o ;wg• n ° oKm 3Z
'+ A 3 '• a0awtem a: .c-aa , ^' 0 ? < *. 0' p cii
ov a a.w °,onc-_. , Eroa —wOam, nTygyCpzO , k�•o nw
Ma n w ,. ,na "'ow oo x� .np n rp0w agy a -.c a- aK m Cm wmw 's7�
0a •" •z A-0 ''?-7C`� _o'A xy _ o7 • �,, ro w a n 71 ncw •O P C.eCt0
' aa _ n_ �7n =p C f0 ` OVi
0 ..]O.- .tn.• • oc -• w or wo , a-= aw ro , rooi � er, y ., o zCr90O7r, no0 % ;; g•A 0 F, µ 71 c• g p•n {71"5. " �.o,. w'„ mil 0 p
a x z a 'p �Zcn * ''rowc, 55
�0 y� o a,b -� " ' rn- , nw .w » 'g oxn , oOo Hn ., a 5 = n x 5 ', a1.On .'3 X
; _ _ °� �7 i :•-3m 9 - -ro
i
il
JHLi
" 05 ..aH
ftfflr
h
H - WiHE
nn n C �p os�row ."' ;i� g w e.�. 0 an0 ° ..„ IS .m• CA 0 < - 0 w a'tnro `< T ovi , 2 ''' O > n "C1 0 n n > p 04 "VW ' p.3 O < w •r. G. '' rDa. n• a O'm `[ 0 0 w,,, a 'T a' 1 o B 3 .3 z.-, �, O , " a0 -? n 6 ..... nw , oa• a,r. 5r
w,7>5w � n ° b0 „ o . °'n r � ai •,y . .,. oa.it A.w �n nt+7Ep .•
orta0Q -"•, nna.'" . 00-,, W _nnw•a'3Sit now O , .., n aq et wo
., ti C C , F;' , p n .a• , SP Iw nw o ?:• z,tl
A ?nPOPww ow �P ` ° O it n � < 90a = wO,Gaa� K ..0aO R HC}C.0 0 wa .-•N, oP' '"- a 0 0 r ; 1 O `t Oot��n o na yan' . n a•d ` x�• '':a , 5 n �
a o , b ..- z., a o roc7 : , .a- O O .X0 0 =O n � =° a.= n ry
r•D el °
yC+7 �_n ° n n -o?. K7 3 nY Y , ❑ naw .n , - n0aFa'• ►r .,Oa , n d
F rn •�'- .. C 7'v'' , O Q .a ro C. H , C :. pq 0 m w _
O p, , Cc rD CD n v, a •.t n _5 7'w ,� O ,,C3 co • T/1 A a ti
0 ID .4 •s n , 0- •w v , 0 " , 0 O ,W ,..^•, O 5 fn.CE.,....—a.E. ntc 3. mC 5• M
0 p O^ `< , w r. n n -crgq•'O •w,- y o'o " v, a oc2 w n S. •2 n E -< " a'a n m�w5. " Z.
_ c n , < , c _ aw �3�.
a.$ r e, N g o . ..g -, w o -, c ° a r,c ..° o.ry-, a..-.0 . r,o o ,s � '' w. ,, a .C9 • -1 n 0-0 cA
yban o � � Oaa o � � mx .n, d7"�, .wj_ vog �aO �wowrcwo•�uao �crll� •
x0Ko�
01 w it wrr inns w •fin O w ac , -n , n O n w n
w -.cn o w — „, co p p, o y n n 0.n `• n •;:.7 'i. 8 -1 O n w [<n h c,' �, a 0�'
m Q+� �K7 � , oa � c,o � a � �aa� w . b ��wnw5.�r,o � + °cwg �oa•a o ,.0 `�
Z'P' a.n ti,$* n •CT v, a
A n Qn , w O w n o �'^�•�•p o �`e,�o•.c A y 5•n s^'n w -•y r0n'� 0.y °e ,n� n, "'.< '�T trm '�'
o n 3 - w ° ,-. o a.0...,. w ,.w o a'w x n
0m, n ..a wmy-.ate ., • w-. ado �.- , y �o� a', y A7' �.
^q w '-'n a ...., n = O , 7 5, O O,'np y a a C " 00 O co rn O O a'•" ^_`t (i�n r..n.
O 'C D c O v' 0- O`< n n a' , n O " ,a_ gV E w p a n n G .m P, 00 •.�.'�p it ..ty rn V Z
cc, O" - `, `" a O -•-n, p-.a. b`, •,w 5� •w ", 5 0 ro 5 0• -0 v, E °n n 0 . 50
es pj �Y.,�.'D w Gt St n O m . 0 P � -wi "^G a•n � GL O ,,y a•,-,0 -v, m -,-•o v,i ^~ �rf" ,�'•
f�^
f3 l'7°. 5 rn -en a og vn, 5 . :---e p lb »:y °'_-w 0 7:2 L<° 0•a.w o a.a"w 4 w 0'O,,,, a.rr. z •W.• �0 c� '�7