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Carpenter, Estella 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. 41:19 mum Dist. No...5.60....Count r ren S y e...�r. .�t�.gQ, t.....C.1..eX1,S...Z+.'a.a..1S.,...N.....Y.... or City (If city,give street address) Name of deceased ES.tP1 lA..I1.....Carpenter �;� Single, married, widowed, , Sex. .F..elilafCiolor �7.�,:� ..or divorced (write the word)... 4;✓�,x'a.�Ga Date of Death..De.C.....27t, 19 4 Age 50 Years 7 Months 24 Days Birthplace ito.€` - s...NP.W...XQ.r . Cause of,Death Suicide- Hanging Certificate was signed by....F1Qyd,..P 1me.x OQr.azie.r M.D. Address G1ena...Et.115.,...New..Y.Qrk. Place of Buiial (or Removal) ....Town.. of 4ue.enahury (If body is to be temporarily held,fill in space later) i Cemetery ine..View cemetery Date of Burial...Deem-..Z.Gth 19.4a. (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, and on the basis thereof I HEREBY GRANT A PERMIT to cewP,,d Is...T'Q.tr:rce. ...8.4...J.iarren..at... Ga,ens...F.rala.,s.....Ny (Name) (Address) the Und.e,r.ta1er to hold temporari y .fitterthe the body. (Taadertaker or person having charge of corpse) ( Ukase of s o ) Dated - .C.. 2.9th 19..4'&.. (Signed) i(YV///� Local Regi trar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ject to local cemetery or other regulations), unless removal is by common carrier,in which case a Transit Permit (VS No. 62) ' required. C iA Ex, o w w •,n ,n•N p O co x O p 0 p '1 xro M v, w '1 4,8 p• .n... ..1y •�� _ s�reM rim Ft/ 0 ..' ° . ..'o r ppcere ❑-r� ro o �J@0Mw � >6 y C ,� •e ^1 c, ° p,ro <p ° C0 .r•t p� ?•.-1 'a 0 OQ o - P. FytP v+ 0 0 O" ,�!1 ` nn W 01 - CS re M p D p p 0 ,.. .. 0"0 ...„� .-re ro O .re 0 ro M O O !f 4 op.m-•Z3 0 P P..1D0.'• A� 'Mt .'7 ''�'y .4 :1.j .w., 'CDrn...rD •w'1A < 'K�a�a.ro .•'tempB � �coD cal% IV Cl7 0'a 0q1.71..�.1zel W,.,:, '.1 0. 0.O.G� ..W 0 .. • (nN(� 0 p m w ro w w p ° � O 'z7 g O.p. O V O w ro ri O' . '..j•,�0�5. W^'r��n (o .i .1 0 - •ro A O o ram'�. a W r� le '1 •.� ... o �7w U1 wry< �'C � toOwrey �. 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