Van Dusen, Jessie 'orm VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tor This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
'illage, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
,EATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No.
Town
)ist. No..33210....County Oneida Village RO A., R$$
or City (If city,give street address)
Tame of deceased Je$$ ..0 VanD $@r
F ... Single, married, widowed, Single A r 2t;
ex Color or divorced (write the word) Date of Death e s 19 5.
,ge 13 Years // Months ®.i Days Birthplace Glaris Falls
:ause of Death Spastic Tetrophlegia
'ertificate was signed by T.....B.aum M.D.
Address fj�R4ries N.Y. �7�
'lace of Burial (or Removal) �s.c;c,.c.�...rc.2ic-s.P Gi.4f� ,..c!'r-'"��� 7 . .. 1 .l.Z.- ,�
.. Gl.c ka4
f body is to be temporarily held,fill in space later) � � � Q
.emetery Date of Burial...��l vwt 3 P 19 ems+
f body is to be temporarily held,fill in space later)
'he Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
ation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
lumber, and on the basis thereof I HEREBY GRANT A PERMIT
Mae.../......Strong Rome.,...X...Y.,.
(Name) (Address)
ie Undertaker to hold temporarily and in.t.er the body.
(Undertaker or person having char a of corpse) + (In r, empv9 o9y otherwise dispose of[state how])
)ated...... 1pr.i1...26, 1945... (Signed).`,.�L.�C -' a1.�f/. _, 2z2..2L,C
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
emetery or other regulations),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
rr.]'p 5000 -.0 .0 FLn0n 0c0000 0 r° ^17ro '1 y A, M < ncr a » Art ytn ,...
p A p 0 0 K rt " .,....0 ".,..,, 0' ..ro re r9 0"n ro o s�'' 5 ., 5' p• C O
°.f.,, "'� " ro < z ° re .+ 6' tr.n° '•tdgAyn a. ° 0y OroV? y
^ el ; O ''�' so " 0 0 n fD ?0•'r-.w M"•-t ro co o�•co .0 m ° co °0 io 0 ^ (C 0p rt PI
z• A' a 'N ce'O 0-` ro ..i y w Me.., ,.' 0"co re •W 007 •W"'i Po cp - in'=•2,M°-'p p;'O H n ., E.t7ln "4 VI
C 0 0 2
a '� ., 0. 0.(y°'L7 ... '.,. r'O yNr•, p roo v,•`fFD'cu �. A ..'O N n GAE 'a y 0 N 1..�
2'r1 ti :4,.< 5.° ", '1'
.9
° 03w- 0-0 * SSO G.7n- P, n •, "w, o p, -'O ae ° y.5.w"� 0.0.1'`� .p, 'A20 n p 0. .pi, 0
At y y < ce o'-4-n " '-'o y ro ro '•+V {{���^+ re- ° pq n ••� ,�O V •1 00 v
p Ny c. .� y .y • re wa Iano-n•- 0O •re OO w ., ', 00ao.w Gil :'0" �a IC 0
ill; way .°n .nw ] �' v, pn . .;< O.a.• • re ° a'0..+,< o-< O ,, to "'O p•.y �V0 v
+ 'obcnea° ° oaywM .. v `D *P Ny a;•`D, � `eraaa ,aro '. t!1 .C"p y
•G= re ., a n ° 30 .00 coy oreew cn
y a.0 ]'Q•-t 3 ,Y @° -, y ;o c re w o '^ *a'$ o vn ,,,.%a ��a.go < o ., n 0 4.g m ozyOp' trf
,e'� Om z xy n w 5�� F,rw:R w '^i o ❑ w o. *o b .s"'0 p a--,,, q y.w ao 9.`< ie r, y 0 rd
O -A M .. a... co'O a "^'< ° 0 c, .0 00 •t y' r'n•0 40% 07 .,, 74 a 5 El Pj �',0 ar 1a
^1 •.Croy ^ ro 9 •, ,-?n n I'e o w ro w �y cn ,-.w w'v ,..,. /�'� '�
D 0pp� g ;IQ`< R'0 ttol ro pp.,.1 a y A `Z•y r1 y'0,0,�y 0 � DOP�w Mn � ti.r.-C�..-.y AT> mg.M QUI4 'ICJ ��'l'J
yp at .°in ° 2O .w..+Oro• •0 few ,_ •, 0.° 0 < 0 y � p' 0 0S000 °iyu '"'rt,A k0z.nM 4x
Or y•'O 0' ° ., y inrt .°, y 0-Et Si ' aR ° f9w "' E ° '. '-� ', 0y'1I!
G n -rti 'f°i0 �0r�•p ° Ito ..�00'�G '5 'a.r'..•� 5.;ro`< r'-O'i1-o
P/'•.1 * y „otip 0 f (~jay
C p C o w � n xa8 ., ° S.. o o . ^cao w�p O o to y O w 0 n y 0n 0: oo ...owceo - w° .A O ° 0•r o' ' w0.ro p ,. Op''<m ,y, g - /11"1
�.�m ---0- cm x y o ;� ° cr "ro � .x a .+o ,fo, w°=w ,5 rwo a-5'o•a; Ea'° a, y oil p.trl o'1
72 M 0.., ro 0 ... •, ° 0rt Ito nto -t0. 0 ....0w wP C° ro y
a1-16, xc, wo -r_ .z03 x., • ^, ,;-cr '" w x.. w � ya....rocymro rn �M CD`. ^ mu,g, � or. .w 0U)
p ,1,y y ro ��� ° � 0 ro �•� p w° k f9i p O'rno yl y y » a-� ren � o ri „ �ro n �o o � �"}�� ,*� ,.4 0 " T >Z rri
Or y�n Q.., ° a e•'y •'1 ."'i w ram.. .~i.• V o ro a 41 ° ° y rt, a.. '� M 'S �I 'IC p, n F.] k
D l"Q n'rtq w T'y. '�- ey n w 0 ,-. n •co,r��I 0.°-n° m ro i3 p, p n , ( 7
1 "'i'1 y . w 4 co Po N Brea p g n+ :I.= O '0J' 00 a n,-, •, U ..w. ° r<e ,�Y Q e y a a.a 0 w '°t O' ° M •! •"y..Cr 9 6 .""��.I i-1
d n' 0 4 0 0 0•G n, A '•N n r.0 Fp w 0 r.ro ' w w G, .0t 'a-O 0.w �-, 0-CI E:o it P, cn a f- ,, - 0 W 0
O �j��'++ ."y � •° '+ ...� ry R- 0.b �.'1 •io ro 'm 'rbc pyK . p;.< .ri'' ° rPro ,, a �' ^ p5,• z-z
Ch! •0 .p p 0 0...w re w, :R. w <'A' pp w `� n'r h7..-
r0 '--1 0 aVro Cq °.,,, 0.0 ' O x"...,, •O el) O w p ° y 0`< 0_ •i p"w .tl. p'R• .n"0 , V1 0
C O�'yr• � 'Tw p ,4,0 n �'A a0 0 (0 r'.,`<0'Q J r.O. aO" .°+,y W"w'.A .fir ET, m`< n e . 0 ro w,.,>. 2 :jC ' F..; ›,=0
,r1 T 0 g 0 0'. = P ,- ° " '' 01.5t.C.; r' P A' 0 4'° ro'd --t4 O 0.C 0-r" r 0 0.t 70
D•'71trl`>o !f 0.1 09 w ° ' ..(D 't 0. on) T w w p ° 0 0 ° O O re co 0 w ., 0 '� '" • P.
D ', 0•0 p,t fD •C y ° O w 0 ^t ...t n pq ro p o to tl7 'p yo 1�y x 1w
1'l'z.. c y to n F2.0. ° O '3 p 0 ,-, ,, ca . . 5 N ., v, <'d h W ."t ,re .a trg , 01. Fr, 0 rt 0 i t ,-J�, w
zzrt f0'° xO �'a",. rn x�'•'' aae OO .1 < pro np ..'_' 5a0 ' 0`� .-I onGL .1 ,tiroa ° in
co p• ro C.0 w ro 't ro ,-t -t w ...rf 0 m "i f `C .n 0' ,� LT1 p a
y3 1�7• ^��7 o n .°, •wC °»,?:�•�, a to o • CD'VP', y'?'.,d a'n 0 o a....f �,,y .•.. .,, �-t R.�'co 0 0 ›. .M 0 72 3 3 rA m
+ 2a =m7-1- ��- ro „ ,7 wro ,roy M° blJ`DOryN ° < rey AOOO'° 5,, ...:?., S FL�.] a 7.° •�• - U1
,1. ..'ytn% co 0•..,coo c 0 °�•B b 0- 'c'+ o E + rra .y.n, ac n ., ° oC•� ° 0 -•aM y C 4a a•
w n 0X0
O ,fDy ° roc•w•�' rnow 'aim ...ry ',•t 00000a..cop+5, Po....Cro ° rao y• , rtp'a, •• I
rlMx
o 0t'�p '< ., wry ro -.01.3 ,- I a.o 0 .'Ni a 0 n �.rE'•ro ro 2 y `G -t -e ' - --• A G_tr%^ x...
�fir+i y_goy0,,,, _r. o °, e, 0cae5'2"•.o',gin .1oyo5'^ °e00 ,, " p30`° an@ a•y�w.,' , U.'Z'
= 0 ppoy �`t0 0'-t nwyo � nyd•..o •, p,- u''o w °= '+ 00 ' y p er
rt hreey pram/, ... et n. ., tAx W C.Ry, ZNr.., 0 m 0 ,t7b '(�. O ryv� .., ..,ryNO "Z t,I4 A
• o w - roo oy xa:n .,, :srn b ° o , ° Oro < .ti< ^ ° a• a.r" . al O
r.., .. .,-ae .- Oo '.-, = roo0w ttq ?'' °.o'� w ....„ ^'~w ,ra.,72.�.0•ti ' 14 °° ''S " oD''`' > z° O '�oTi
. a xtr ace Oq'� y w M 0 co -�Q y o n • w.r' . a�; 2 co fD,ro 0 w 0el, .,, o y.,,� >
i ^ CO ••1 ..-.= 0'-w-n ° to '° a O c,`< •'_0.< 0.�•t N ,"re y N •f 0.~< .-t y0-`^ rt .�i' �,y
i,A O-1 A •'01 y'w to A, �•°i `.3' '"'M "„ w-• 0 a fp O ,.,•.. ., .°, a' ""'..Ort n M�,-a ry0 w w ,�''kr tp n• ~
a .'01e ,Y. n _a 'b w o a 0 ° h1 ?� . ?.' 0 70 o C^ 0
ro �� n - + , 0B a8 < 0 = Ycr--., •, 00y � o 0 (7 ,, ^.4 t11 .. //
03c� o ° 0' y,0- o. n nx •1no o- swrAon :•, V4 .- 20-nofDnb IT/"0zs ..E-- 0
ii O 5,.". e•1 w F,.e. 5' ao g. ° m x ^:.:n.•<. °'y ao °i o.a•o ay N °N.0 o 1 ..-.2 Ort
rO .t., ° p-
4 t�r1.°., A.�v `,, ev 39 ° a co '.4 .1 cne .�°. ••-• o 00 0'a°q "e� rr'a`d�o 4.E.w 4 w G-4 ri' a rre °n �a�o' '