Conklin, Madeline Form.VS.61. , NEW YORK STATE E PAItTMENT 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. /'
Town
Dist. Nn0..Jt/1/County eelt_ Village //
(If city, g' street address)
Name of deceased
�erSingle, married, widowed, •
Sea--/-N C.Color •r divorced (write the word) G -lf Date of�Death 4--c- 30, 19 Kr
Age....3S r Month V .. Days Birthplactt .P,� A.... .... .....
l.
Cause of Death.. --
....... ... .. ....
Certificate was signed by ....0:... ... . - M.D.
Address a.per- )1 , '�
Place of B ' 1 (or emoval)��-dY ..,, ,�: ,
(If body is tq�empo sly held,fill space 1 '
Cemeteryl/i�!•t-o-- -0— -� Li Date of Burial !`-.14"r c2, 19 VC
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the alp./ e 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
Noumb 1 oq�fhe sis t ereof I HEREBY GRANT A PERM
--- '71-€(--ee,2 4dt•
/��`(Name) 4 (Address)
the... to hold temporarily and.-.. .. . the body.
(UWertaker ar person having charge•of corpse) (Inter,remo 1 o of se dispose of[state how])
Dated %�- O e- • /�, 19..3L:ar (Signed)... .. ..ht..sp 1 te-/
Local Registrar
This Permit is sufficient for the Removal (and Interment or Crematio of a body to any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in whic case a Transit Permit (VS No. 62) is required.
r•+yo 5..0owg• Ny.c.nmo o ro000 r) r o �exro " _w -, <a � m 0 G,.,,�w ,. ,
c 4 .nt * c0A, 0< 0 ro .,....0 ,„.-,...,..,c.m 0'.n-,•° `n,o� wcODvnga° M yoo ^o n›...1 p `gv?* 0
0 " oc ., ncnn o-_5.� 5 ..* . " 'G'r"D � R o .n5 ro " n °• Y y.0 a r1 Ciyy
/ ,(D P•`° w.P '1 .-� p) P'N W GOD ti .°'S. M'.Y n fD '.TdQ co' ♦W't n �^,,ey-P~`Y v' a."O :'.••("D y n `" " N ►4 ry p"y p `r
Z::}�y� P eroa rDPcro rD �, < , ca; in ..o ° n cc) trJ
;a • "9 w , o `10•g ap, •, n w5° .5'.. c'..o wnlJ(10 n rn .w, n P ° ro �o .M.? "' w 0xi7 •f't ° R, 0 d
A ^nw `ec"c5'0 ., (.„ O,en " _'Oao. o-cc ...o0- .i^ -tn- G " " yow a.� * h p p..•
^'
K !B ymreA ." � u," w .y .., en a' wG.n' a2DI U? r' o ° w " R .5• CD O ra 0 O
"..i.. x l.� nrPD . .,,° n zyw . ° r"D n� r(95'•g• rDOc-�-„r<D rD 0C 0 'i w 5 *w n •N� �" e c �.aa LQh
roc ° . *o Cav CD .. r, y,• w < opnn *�w ,.° ;r ° c w . *o'o ,.w!o a � " •,- q . ^ `rtt f47 �fnP �M t' a n W 5'Oe10P..t CD eD ,"'o .0.0- • c zQ nww _ 407CM •m
r ›P, p Oq ° ..-4..,..,0 CD 0°-2 p'a* o iD.�'.po n i "-* n �.0 co 3 "y.ry w 5"Q 0 5 ,n,N o " w — K a 2.n�R 4 z
0. m''O C - to tn'CD w • E 5 G r, `+. 5 O .. �. •••D . .i 0 0 '+ r •\ w„e"�
® :00 00c0 ..nro " ' ate• 0..—c°p0.?; ?? 0-0•» n"< N +� 00Y0
4 0 z oq G aco a ocn . Oro .-", 0 m n '" o w .c n � w P C� o
•
'+'0,0U' oc5'�'� c Er"D . ac -owcc`po " °o -t0•rae E. . o•" ,111, amwnA, •c<wD O yOO P. °pra ►��"rJ
� %tim c0.°nrc-� o °n+� cGOc% .=:r*...n5',*�Qc' 0 <a.n0 --02 .--, 0 .0-0-rro ...cflu �, � w�"� �'tR.tri� "e ` t�'Ocn
0 - 0 Tnw o '1xp05 xY " " y .•.rr.•. w p°' wr;'o " a P.¢. c ^q...c' o t j ° a ° e °' .. 0C=7
' z ' nraG ccn rDP.'op 4":' (4 c'8r a, r" -^0'8a' 5'",c-cDm°E. " �o R '"'` H
pS� 0 -ws a" 0 ° r.yC'" ti °= K :.wp "K n ,, o ° one 0 5.ac �p"p �'
0 w ro o0 0 0._ `i n m
r DI 0 y va o .d " w r..c•o y ,, . -.° ° c , 0 .....0",-,A <'rD 'it,' 0..»,G ° o 0- r w •
' .Ti.1 �n o'* CDrPDnr•t ° 50.'t .5 c•oS,ocac�,.. �,C2 ° rD ,qaac'`< a.a0c,, °+" � g CI .►�Ao � "'�"�
° 70 "`a<.o � o ° n2 n �* n • � Gwa �nb cG . ° c• t..
5wo ww " yo. ,.." o pr
pVr ...-0',.:. ..G.a.,...�_-n ar.� G'w a,0 0 `t.•1 P•rp n O•r"i, n`• •-.-to M fI `< G C� r"n 0�, a Psi p Cr1M• eS _ o `�i
to ►jsnS• 0 r,wac c.y•O. .m o 0-:::::'.Oq :'., —o ••° .- 7 ,i °` w c w 0 y",f°w ti p x1;, 91 to0r)
.+ O - 0A, rr2tnF4.1 ryDO rD r<D`<vg5 " n' oyA?;rDOc Gc•GrD . CA'" * .. dii n17~jp K n 0
=Q ° .�w ° C w,•'.N ° 1�. n ° " rD M.-1 P• M, .CD N .-S"y ti t< G G to�, ' 'j "' r ,.� 0 ,' •
• W."
'r1-1.. �;0 0•rc cow ° , » " D F o �orDd " D oa�aC" t^ ►.°XI
"nx5 Fi a.'nnq r a x n n p.' ., g-x0 -.,G ,., ° crD .9 P w . r £ ': `A
0 p 0-5 n w0. r° " o r° * of ti rD ° w o °* �rDpgro ,�yp, 0 0 0Crl t9 �Z'
[TJ y.inZ. ..-S N n ^w P ,..t,, O q n P 0 n n ` C O n m 0 C'd -t 'is ,..w n rD ...P.� rD m." rD P.CA rgC rt•a' 8 �7 pl..)
0 x Z o P.cD ,,f•0 0 w * rD W 0%.,0 `< O O n .t < o n n O N= P.° O -, O •y, �'!tr/r • •y 7 tTi e�pl
•, rrPTI 0 - G.w.. P el N,o .-.•y !D ""Z'°N O°O r 'tZ'"Z G w '--' r"�D y rP,.O C r'�p b •"'i "ham w " ��.""Y O O t/ At Q ►7 /r
0 rOD � '� cDnrororo G w .•.0 onfo5.= 5..xr<D ' ° cGr ,y .„tip." S .•,jweviilft1 nO " 1rDP• • '-tr.n " < M tiroy,0•w N e ..7 y WA' .,." n x 5"w .' o -•• n e °' '`e Pt7 M�'
r 0 ,� w aq rn Cr°'_a"�q CCDD w R,n.0 c v= ..'c C'4 m ' rni ° " c0-�D, Y n x` `a'r g:s Z w t-3 ?e p `c N Z..
a r,. n;� n ° o" "' " o,rD•0 ." r, °o -, r�.P 5,G'b - fy. , o p;5' `wi `t P•y.a 0-0 a.-^E.
0� �: "',i t
o f r,Z. 0 S 8 . 0 , p' O " 'b cD o° o'`i`e H " 0 . °,a n m rD S n N cg v 0 f/1 • t'j.,,w , E
p �•r Ov, 0'"+ P0-�'�-t ny0 nv,,�y '* "+ w" ORw ,•• '"too.. SkiG'p- .`C.m "'1C
• 4 0.- 41 P' ''='n r.v,'rD -� z-.G; w fljfl
l ..' G " OG t.- °orwD � ° R ,0.0` pq 'o^" p' g
W,<.C.:D • oROG � p rD riw. Dwn" eZat aac 5' o *^`Rw5 "'° c < n 2 �+ 5:a'
0 ®ro •, A, 0 0...-
" W "''�° C',°-4-.co .°., `< P rD O P• 'r�rt w °.y 0 0 z- r=m.a ~' IPV
O m q - n c 'w ", c " w" .0 '0 " " o n p-" 7per 7.
"'.... mD• ^ cDrc, c-�cn �� boy 5• � oSo c ›c-b" o° yoo w•o ,'" o;,e CrisC2 m
� � � ooGp°a:c� � < � gym" " no :, a 5 $ � ° " cam 'r", wo�"o cro M�z w
e °a ,.,.,.ti...rro, ';'.0."'•" O.Sr`n r"Dw �",w,tK',O.t.<• P.y$ Cs.O- "t0•'',O GhO �.° 0.nr ^ti �ti; 0
�t�i1`Oi, c•mp'wnrSDaem -JN ?�° cnD :. `ct �� � 5'a ° 5.n0woa5w4wx° ni8ac�e �rt�p'vr.rk,