Austin, James Form VS.GL 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 CERTIFICA/TF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. /
Tg-.1TV II
Dist. Now e/ County /!/� \,/.,GC,L Ceofe2 .......................V a g.... ... ... . F
or (If City,give Street addre
Name of deceased
Single, married, widowed,
Sex. .. '.Color.. divorced (write the word Date of /7 19.X.
"' 2-.1
Age �',� Years � Months. .� Days Birt place... .
Cause of Death 44... .. ,, eft -tee 7jtq 444i'
Certificate was sirLa,ed b
Address .G. .... ... ....... . e......
Place of Burial (or Removal)..; 40---61 "7"
(If body is tggAntensporaril . held, fill}}space let r) �_
'
Cemetery L W/ *J F-4�Ytsa�� Date of Burial..�l,� /7 19. w
(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 acce• ed the same for regis tion, have recorded it in my Local Record with the above stated Registered
Number, .40. on the b s tl et EREBY GRANT A PERMIT8-4 A le
f,,,er--77,24,
df i e) / (Addy
the :....... .... .. .: to hold tempora • and. -,�Lti�'• n� the body.
(U• •rta.•r . person ving charge f o se) r rem o er • dtsnose of [s to how])
Hated ..d.. - 19... (Si
gned)d) r ,..
g c al Registrar
This Permit is sufficient for the Removal (and Interment or Crematio of a b to any part of the State (subject to local
^y or other regulations),unless removal is by common carrier, in whic case a ransit Permit (VS No. 62) is required.
o5'04 5x° owo mg...Imv'� n, °�.'$ a,,o9 2., C"oc~opc% n �•'n � < ooExa5 .;,'< p�ycn p•,"72 o
r� n
M+9 R " Q' a.A f' a�•G n ., •w a•", .,)p w n pp a.'� = rf H ° p .a. A tr7 'V�. P+
,.-▪-29 a 4 n o to 0 a-g a a m o w m�'C 0 '.='riro el .,<, f`a ` c•c'cra.ry-0.b -,_rp w, _ B ,,n oa, trs)E jM t°rO' Z
Z. ., 'S`Cro acro mNn a n w A pp •+O n `C w 0 A '1ti
o w ° ', CL 0w0n :'o'Wp.i.'0 ° 5K! a". W^' wn •, n p, .w.ro r.O •'+:c•.. a• .4 0 A ,r f7. ,0,,, V
A �m �< a'� r", p t « a aD. n a �, w•pgn' .. .4^n e- n •" + ZA o w •4 E.�. r.« �° a.. Q
00 •r�; n ?+w r,' 0 " `A ,, y'y ~ n n tO n a"�... a 0 .rp 0 o w ., •, a s '"-'•0.w N q A
•"• ... g.< nran0 "'a- a = w -w, ' rl. ^^. ti ° Vrpe ".1 < aa:p'3M.Sr'.nob5 M,�n "C�0 e"0
; .,<r.,,i ',o 5 * a°,2 a•o a' n n '' 'w 0 *a' n o'6'� E. " S a:n' y p o r. A w °„ o NO< y0Z� iA
" 5 n o 5 m w 8 0 " * -0 Co s4n ., w o.w a " a .0 d A HG0' M
• Q0'O ..a' 5' -I _° w C ., o v n a. a=ems' p n a a‹ ..n ,r ri 0 ��w�r
o x A y " w•.,_0. •-••A n�o a.4 `."`� A,C *g'y "•a pap , CO ,^ y Co �.R.�. C..°+.`G" p,G �. �'�tf Iv r7
5r.6 nz�,q -zRAanawnA z`•n ',. � M •o 0,lEnnww ^ �nR �m •+op .y 4a0tooi. MM
r n 0. y y o n r'� .a• --0 g M ti •
o .prna�ea;' ti r9 -, ° � w nw y +r V. x.,.9 nZ
a0C 5, < ry orp•a' w a.0 Mn' o Se yy `+,
7 C. yp G " y N'rn -, w �i < , ,-,,, (4-1).,4y w O �, •• =, O ��„ 0 '1 A M.*,..)
cf• naC " •-t cr= 0.wa,000 * 0. r. 0 C 5'~7,•5•^ owa" nm5a'o�w f7N
O O w v' 't n A," y ".e3 0 0' O '"r' p' alp o y '?, a' '-, a v,-a F, G ° 5'O" W Q
."no x " O n a ro Z -1 , 00 ., a. 5...'0• m na, w :; w< C " a Gm � 05'O e 22MQ
n owt; p afs'w' " a -•o—own, o T' ..nwaaA a an y Goy �m Q y C� w fAns7
a,� p-
a .,'0.r' .. 8 O -, 0 a •"ro ... .a' .To x O n w'-w rrD n'Di ri,' ►' -o ''TJ A trio 4 r.
7D a act , •, n ,..00n ". n nvX c." .ra ar ".H w �r
O .4,H 7'nwo 'O+ X 00 " 2'� " " m ..cai.' w nR• w� p a .-10,—fDa•nwn �gngi.,",rv. r„3 RotoA rt �, �QN
n "•� GO a � 5n ...•do a.00 � m ...nA ay ",Sm fS 0-* Zil' " no `r 1 'rr1 G ' a a2M
n
°c.xZ a °; a " av R�•row :; a wk ".w"�a .n". " oo arn' CD ., 9, opr, r''da.:'00 " `.I. 5'my.n-p Q.e>4
try O a w —nn w o " �n N G " ° ^ P A ,r. ..,•
* MO yap roo " a _. < a o
n `ry,.1 A a'nn rD n * " O M E. 4 o S:pp.._g_,.,-,..__-.. r o` a•_ n..a�g'c E." F g E rri A 1
m V+ ,n+w 0 O O o rD .-. z.'a 0 w.o 'm." .w.a -'.•, '•0 5 y w '.�..m•w G'�•"... f"E n-/ �,' a 3.• .' ^ ` "Wi--,"O
n a a .aaa a "act.w, Aw0 <'?' n 0y n .y * < � C �^... I i yt',7 '.e •
°c \ Z
OP ..1no. 5a•o2.wa.y �35 ° _.pp .a •or. 0n ag0"y cr01"w �wA a '° ..j °r x'"a �,TiO rt N Ea aww'a• ',.i - y "' Bart g'<oqm-" O ,"-w °.yw ,e4ebr° Nyo`< . . a —g-9',). 1 p, �=-1o5 "�`� 0
... O.ff.' a..-.w ° S .-.5.m o'a."4. .re`e O", .+.»,tey '-'" F.r 'o'r° p A'b y " Gi ran "o 0..."y pm. r 9 9 M,�-"M
.. ,= n C.'?pap w g P ..nn ° 0 n no w N' 17 a-?0 "^C ." O v'ro " G.w ^, g » .: f, 1-m
trl 0ro m mop ° " " ry n ro p o Q~A A try E 17 x
o A� ? y m n "w C1 ° o r' a '"n n v' 0"o r' w y <'V ^, w rD n 'la.� t� n." r9 1.tin R a,o r O: M
Zx.. rs a•o a m,ro n x0-. P., o o „, p n r' p re a 0'.a 0 " o rym 'tin w G: z „�M
CA D' co a A_' a w : ', w a c'w " " a w'— n a ,:,,0 C xro u, a, " `< »,a.,'.._ `G O M
0 • Srim nC — .— ..O0.yr' .. yO'd nbroyy R.n yf° oay.^ro :,'•ino'w, ,c.a-r'�po0 ',� ,000O * , >,�U)
o AY.< arp '^"y•�r"pM ,.'pr' rorort"ar''�y� G < w•.< " '" 5 '' ORa'aa' -I .-.— ¢'— --0 .M ^
d y E p,, ,.a•0,rrnn O'n "aR•5'd 7p• .n', C< y " 6. 'u'n, a.0 .;r' " .a. ro ap 0ro m'a.w U] O ...1O « '' 040
5'n p'r c' ° fD°; a•~.w rom5� '' n w o -.r7Dpap ,••.Y,," -.0 5 0 a•E r"o °cr 'a�tz•o.r' rs •a. y � ��5 r M M Z
" pGTrew'cnw . g a 5nc.,.nno a n' .. ,, 2
m Om '.< ^, wrnn pa.c ', .0.0 Na roogw n D.m " ncy k " 0al.awH,," A e ,..r
0 6 Cr"e y' o H o m ° w o R C a 5'� 5 o '"�, err o y o a.r"p a o o �th a h y U x
A m O w a-.1 a a.5•" n D ° ' n w,C " A'" O w .. " y .,' ,^ p- M�
w < v, w ro r' 0"" v a: ?C Jf'n ..-, y a 0 .".C'd a'`f° w ro ry rn O A N Q W
».� w nO Oy a'...n ., ,0 'C O " p 're rn < m " "rna.r 2• O
e �� ,...y ro y. 0- 5.o.0.S .-o � aon°, w ,,y �,a•- --S.0., 5-,-" cos oa-� .1 o ,.0
.r "Z C CY 5 pp' 0. 0 . y a M Po A.2' 0 r' ^,..0 a ▪° r' ."' C "'1."
m Om " Warn. w ...•.,i0.ap-.•.m ...�k`<z`� $ gi, " *0o.x"'�n.-nw °'0 .3 " 0a-w� x»a i0
^+a 70A 3 rno a °r-' w o �' �'pa o w " a" a:a c ,,ti" " •w o .n. L'_ a" - a •'Do CA C.)
0 c fDQ".oy ~"�CO`er5n na"� 'p+ a ° " 9ornpr" "on0 ."," " 'Z n' n tl�7"Ox� . M
nn0 �,s,oNEwo� r"' S S. ,ti=° ^00-4.— " S5 aet. 5'n' c- w5 ,-, o mGg c°
m �� ° a�.a a gy w n N w pi '.n.S ° o F a < a o K�' c a"C.� v", ^'g VIg Q
A—O m_ g0_ ri'-.-•".n.0.o n -. pp O'".T O'o -42 rt — n n ...n wig VI}• ►r