Silverman, Herman Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Ur This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Towr
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE 01
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
egist red No. 3 se,
r Tti wrr �(
Dist. No.,J GD� County.... ......,�.Gtlic'["N..- ge el 0�
lty (If city, give street address)
Name of deceased
--�_ I J Single, married, widowed, •
y...
Sex �'1( Color I/ or divorced (write the word) Date of, _,De-th T S 19
Age ,C3 Ye rs G Montt ....f Days e , ,� Birthplace 2.... 4 -
Cause of Death...
Certificate was signed by....., . ... .u-•=�T - --M.D
Address6td
Place of Burial Removal j ,a. -' .. .... . .. . ....... .... .l ` ✓ ,
(If body is to be ter rarity held, filUe pa a )
Cemetery• I Date of Burial ---1<"°"1"- - "2 19
(If body is to be temporarily held. fill in a ce later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami
nation, the same appearing to he COMPLETE, CORRECT. AND SATISFACTORY AS REQUIRED BY LAW
I have accepted the same or regis ati n, have recorded it in my Lo Re rd with the ve s ted Registere<
Numb , and on thl�/ . there° REBY GRANT A PERMI
to
rasa)
the to hold temporarily a body
(I: rtaker or ersou wing charge c m se) n ov or of trier iso f(state h
Dated ?'/ 19.. (Signed)
Local Registrar _.
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (su ject to Inca
cemetery or other reoulatinnsl- .nle.ce remnant i. A....n.......... ........e.. ._ ...t.:_t. ____ - 'r____:. o___:a ive wr_ c.s., :_ ________,
En cn
T A .`Yj .A.t O O.O'O re .'+•A OC'C�,"� "". O .... .°.. iAJ' • I~D 0 t„L!~9 =''p, es. t O =S G.9 "i+a•� o r, ►1 u) •/�r�
n 2 r .1O a' Ar<9Cnn. C ''1w .+r.�'w • C•...,° --F-0(gnama mOO S a C7f � '7� 0
-.2 h a-f9.tt' ;P " ° .gF. V, 000D,C,I -rw.?'rCDrSD -n^r'aac0) .W"A'I ", n - ''' -.°, '0.'05'�ONs .1 °�,, PCC< p,.•n100 A Ch
70 D. kl w ..O "'I a 3 act.Y'•I , r.•w A+,..O. A En cv n p r<D -'w 0 LT.
.1.'
oq C A A CA Cf1 Pi`C 13 p A Z
ri
9.y� y w �raw < y0 .1la o 54 ...y ,.."n° cowaCO°..4n'n .1rD- c ''oon ; A 'ote.o'w�: fis,„,co s g �x'nt oaOv ....0
�o x nraD °1 ,..,° ; p w • NOrtrv;t �. ,tOR 7 �.O..a,0 < A C c"D NrCb •••• �•� �Vip v O
;• .C=,..1 oo A a�,A =0 aN n 74 r' a' . 3 0 •R' A `o•aN `4, 6 �.e.a0- •5.A o o Z-• )<rli ." i0
r T n 1 m A .R. N ?'n .7 A R7 0 •+• +t 0-r' d O>1 �5" A N O o` n < w ° O `0'>4 'A.�-,CR CA
a' .n ?' A �w• 5 w 'e ° = w C *o„I; ,., 7 A A , .�y•�ao .» �� 't H °9. ae ��- `•�:
II �'.cn -Ai a-•A A e, a C 2 N O.? a4 •1 N Jf. ••s4 •.. ac 9 ►� fn "�`} -
pi ° Z '< CAA .gC7wA � .-s. .740• .3nryaG wAnw»,,,,,t twd � Nr.WA .N :'d ►<� .i
a A a7 soon G a n n 4nAa''� O- °q onww nA t Iy K nC)v,a I''yM
• �•a o oU ° o A aA a A 0 .] p A w ,�A N o A o .�;:.g .° 25 /.� �'
QII An1 .' y.b C M• O As•D w ry A M '.]' a< N A w O O n w O ti 'T l l "t O z N
CA it „ .1 •1 Oq C a w a 0 0 0 A C... .0 •+A a G N'C K•O w ?: `< 4.�.O,O K< •'""1 0 0 .'D O �H
x ,o 0 •t A X N C`G p O -.°"A N 7'd c N .Ai wl 0 a 0 n N w 0 0•w 5'4• En ►y p75 a (�
on n �' M•A, n' Ap'"'•a `o •1 •1O ,y •. a-.y 5.»,o- na. w •Atw < •1CCwC Vp'O C . :� xi o
O d ° A w.. •1a * O wAO AP An CO St. A M A M N O ••• <mw W
�.PJ•e h7 3• ag w N 0 1-1'" ▪ a.".o •� N-° 2. o� w w xw rac i'-r' v•w a ..n Q' 8 DT1
PI
'� a•1 ro £. o ...._ 2 C O A :i^A _'A * M •,t o •1 O ❑ go Co n C;T•A .w N ° P' W PI re et ti7 O 't a
0.� „Aw O '10.P0 `. 0-4 ,14 N Q.a 4., t iv w a.....rD wA A ....-. ! n y... 30�' ►j > r A A N .n rfl0 A O ° '1 ,a 1 f' A Cnnn• o ^� _
y�2/a y- tiO ,�-- _•.Opy'o = EOKMr= Ili :1 ° N .n°r�SyAs�Cr.CPN'5xd ' �0 a "1I "w" y K '- q >2Ill
MQ7C Cn N � a .� w = o N � , - rw' n �.w w o °o n ...A -1 1 C .°nF 1 �` 1 e .� p 9 ,9yC✓0 no i
A2AtiN y' n7 o A nA Aao ., c' n kt,C w '1 n A O 3 o oOpG n ,.-, .0 w-, C� ''�A-A'C -1- 3 a_. C, r. r ,a a.0 0 0b , A . n g0 ;� w C 0 ,•• :, � $' �' c , o a e y6 •1 -, A roO Kx a.., .•1A ..1 7'b N w w a • < I`w o~ C N 3 o 0" .oc w .Or<D O O �N`< O•W •1 R'•�...o`< O M G �•'-• I C,R'Ca T,.0 -� -- (J)n Z
•0..i.. 0:7' ° F• .^...r,, O'rt CL' io O -,�t ?C o a S ° v ^.R n u C y h`G YY'' C y,- r .`+ e..1> -/:-i: .t --1.-- =0
►T,„`...5' n. .O - P Q`.-.O " ... n R X•1 A n y w ... .._.° C ° A O `I M rrc ¢•F2_A'r .J. t. O F rLa'y, . g M PC
O a n C n ti p� a n A F .-.w N 0 O :I .., C rD fa-.w A, a f' r+ '_4y _ Ic+ /.r
Cf o0 E. 1 ^ O C p •S 5 A O w G r.^t o -I A' O a C17 v O
�' n ' N n »0.. O ..A p n n , 0 -I y <.o •1 w -.-I A v.a Q•� .1 .1 c•g(n r, :.•ar O =1- o
•
V' F C w 0 w •-• '1 A AD ". ,-'I G 1'F ,.., 0.. .,-. ° ^ A 7 ..:1 .Cy ~ .-..S 1 A - _
i W -. -. " A N•D N A r. „ R1ni
•.,,� A ?N .+ •w:4 A ~ �'^'O O k7 m a tn 0 -i 0 '. r'r ��L
_mC7'. , cw.tinw° " N o r. rnm s.0c ,. n c. a.ycrff , .-3 m 0
' ".O a `! n w rt rc _ x•O ..I ...r••O .- N ..'C as w n r n 7,1 M v; `G •i C �,O.,' --,Ir n l �+....
4 z. n ni- _ ..-+ ^• °`Y; O G v'..O ,-1 in'rxD 7'O.0 - r" -. O a..S- •wi -. 'rn -'n C.►.e. �.°n ►-i
ro O en 7-0 ,-' - ^••, =n▪ w o x n y '•Ct AA''-' �+ ° .:'0 .1.-n 13 ti W as'C U� • X
.� O< N yS7 `" A .' y N• •S' .,'0 ro A .+•1 0 ".7. "1- b o rp N v C• ny Q' x rT• /�
.�CAp w ��y0.0coONA0r.�' .w.1 - ft .O000 wC: `.C!Onro ..,y � . 7 .a.CO °r Zo +SO44 -• O{►1wl
o- n7 n '%ii ., ° mac. " nx coo 7:-a0-,, ,'o �w , 3-�•ary '' c rOD -Ic �' 5o .� �. o C7 ~, ►A►i.
R2� do ii ,,., T wn ° .A..O5 O o,,a8`G -•At P'A +• c»a A A'o '1 a •.; 0 .0 ►'.i""c.rt 1 '..w�y
n Q ?' �.f'''w "^,.1 O'O ..,A ...- `t A N _m O i y C r'c,, N . N, A.•. O O. ►,,r.n r PZ
'�.X„5. "n n C'� A w`^•-o" = 5• ,‹ o ob w Ycrc 7-ti o y•.w-s a- w•o a + Me C� 0
+C F °c.c 'a�kF ' �`< n A � ^ 0OR0' 5 - 0, O :9tinc ; wo' '",—° Ch'0Z m
,r•, Q7 5=.--;•-�.rt w 0.: _.� o.0y •cJ rt ..! `-..AC' ;•rn.< 0.7..e C' •-, ai•o �N ° O .` et A dE' 0
L- o - _ c'•� n % ~7n. --o n ... 5 C'-.O cYn .-:�? ZM -.° .~.h n .. ,`-. ... .-.n wB Via' .1.1