Rozelle, Allan Form i S.6I. NEW YORK STATE DEPARTMENT 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 l CERTd ICA E OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Re •stered No.._. j
Dist. Noel..County 1/4-1 xne / �
)=C1ty (If city,give street address)
Name of deceased fr•
i-rt--e, n ieri, woi4wrred,
5ev Color ,., 1 v44:ci i write the word) Date of th. / 19
Age —' V r ... ..1(ou ? .,, D s Birthplace. .. / --�":(/
Cause of Death . . •
Certificate was signed I,..�C %E� M.D.
Address
Place of Burial (or Remov- )..
(If body is to be
Cemetery Date of Burial 19, i:
(If body is to he temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been pre. nted to e, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accep -• the same f. registratio ave - orded it in my Local Record with the above st ed Registered
Number, an.�on the basis/ e ;: ;ITT :,!/RANT A PERMIT
to - ';� s
) � dd
the /4 0 •
'
to hold temporarily a d.... . . .. b,,,i;.
( �ertak:der per3piving charge Be) ( emov or of eras' .sno (state hot
Dated 19.. (Signed)
/ Local Registrar
Thi*Permit sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
rt
•
•
s y , -`' ? C rD• 0 c�•:ru. w ,oa . r,oa.° .i tD •°, r: ; a a C r, o vo lr)
uy>'� r w J .i ... 7�n rm C '••R�.`?-7..r/p • 7 -t rD = ib a, N ....b �'`t ° rt - m co: -C a-: a „ Z
Z...7 '" E v•:" w 11 Q.G'C1 v' •�. •'." , rD rD V,N r, ; r<o v K °' n•". 'y 0q w ° ^ .. V1 o [17 Z"C w p A
V 4' 41 V° -Da.3a';' " r •". o'3-7-Or w � »� o •p : w o Z ., o
D '11 pci, `a < 0 ° n N °4; D . ,'' Oo. rb O ...V`D n n [°D " 0 15.n .K cn, r ri ° c E '� -_^Si * a v ++ O
°."n4 cr: ro •' w C,n ° ^ u,w 2' ;n'a •• N ^ r rwj a0.�••Dg• <; ° ° � ` O O w ,- . O.2 Grt aa:: 0
n w 4• , ,, , ,, os „n ... a a�'oz • ,, �'- . w - -tom. � rt toz"�CO' "zM
Om - ,_.� - F 5a�=^ K ."� w C *r°,y ".8VO -t G'w f, �T•a"7 w N.° <,- ►.3 w.o /�1�a 1r�w►Zy
n t n N , . G �_ a E - 1 w r a + �r N M C w � n w w � F+ w V T. �.w •� .1 re 1.,c 1'�L•�
t . 5 ., 7'' ,., A rD G-'.t _ A Z • n W-'";''.�," ° ,n.K C - n -'i •'.�'" " '.. w w ., •t
oCwa oa ° <'-°� ° �wa °= ° 0. °, ° w4- `° n �o � 0 •� w5' o6,� o :w �' n � w2.nov 3Z
Y R. �•b ,- •t y m rD ° w 1 F w 0.M G ro w "' w R O .1 ti 0 .-i 0 o ', A „"'�pi
CA
D WV a Z 7 w z r ...W G'< ' O c .., P m a ° h 7 v' rD ° w C O M N CrOC/5 Co C '`' o
oO C c a =a,'� a.- �nwao A'S ° uwn-fam a - 0-aDa . w �?, cacyp NL O daOm . w JrVi'T1
s. a CT1 7 m M(o, ° •-i b ...B- ° •. ° rD w W w A, c"o 5i n Q'„w,ti o '37 t17 o s rAo Cjt7
:U _° t3.cr, x9 _, o , , c o �n '•,', B.•, w .t CL"S --° y w n a'g to ,"1 w •a' a fD .. yam.'O Vi
' nj„M 5'A w ° ., '4 '. "J'C '1 y v' V" 7 �,n R"' A' rD p ,-,"1, a- a K 0 rD ".r.rD 0 D�.1 I .n.+ws to 0 G - N ►2 is
a w : ° 0ptE
Z =!si1I!tII!II}
='.t "Oo °- =u�y '°y o O v' to b G." ^t 'f W i '�J y a t�i titoPC ^ �, .5' !:: I!r4;!:i
o�wnN vacray, R.,gr2�'�;; cr� B � :�-ram n A ��i��+�.+"'3!"V1 ,�_,, * 7 pxi �'.mayy F; `, v' �'��C rCc '< "Cr� °0 2►�,2i a 0• � •, - � .o`< • w ., ' a 7„ . a'' ^'--7-n"d ViCS T „ °•y.0'Q ,C �, a. to W ::-V,.-C,v▪ ...„...„...„..„..: .,C..rg"-"S•., -e _ • .p-,..,Z ._
.'T",+ate'„5' a 56 rD 7a w" = ' G r rz G(-.rt :., «3 < C ▪ rD O n• a N c,- ° a, ,. '_7-' .p
� 0.
1 Ca M+� S v, y n F, C., , O ,.'o = p n r, •✓'•, C p G.rD ^s ,,. < . A' r.. 2. 7:G•^ -s C- , ' r -�-•m - p'• ._7 rii
1 7 x .. �`r+ S" S P rD w `++'t ,zr`< O ° •"1 _ " '1 P m N 7 l'�
.r1.r,c , ,. =J•7, ..O TR ❑ ., , v v .. '� .1 '+ '' 3...r r ^ G P. ; 42, . A 'ry<w :., ° v' �' ° '' rD v, "4 `' ^ ,.rro „' ,' G ro n ° =- . , . 0m Dg nrt...istcs
•'1 r ' 3- a ?r -.." n r,n ., v"', < '4 �i < SU9 .,a° n • VI 0 "1 H •R illM Z
5• n r*. ... • 7.-_ a rD = 'J�1 '�N "r'', ° ❑ '- r7•. ,4 -'cj,,n -.• " .j v ,. ....•
w y
o ,.-Q v: w'.7^ _.s- " m ..7-i W w . _ ., r .- v `G - G _ ...r+ -1 12.E
q' r '' o n m ri 6 ^s - �•" ', O ,FC',^. ,•,,?-O 7 n v ., ° .-.'O r_w ,4 P r- C s.o'111 .., W P �• ` (I)
>a .5 < N ,.'- r r, ,'R v' K.'Y V. R .f ° v G ^ ,-1 �'�''-,rwi, < "s = r t'� n GP' a ®nr
. ..:P 0 .., _..wr 2 ' ' •n -' a., °0,., ° rD'C1 .. ro O ,-. -, 5,<L.
Z W fD '�►.14
r--tn r, � „ 3r, 0'� 0� w "•°•',yD, w ,,r ._•. < y ' .•.-- ., F ° o C1 '� R..
C 'p` - - ,-. n" --T y Z rD Q.C N ', .D, R '� 5 a -•. .., • -- 0 ...j-5-; c rrq f 'v O r• r -._,- r. r • 5•..,"7.•' idt
` - C '1 ,; rc rD13- -, 'CG ] rD �' °wY v, y r :"� Y R.ry A, C ,v.. •' °a.•• lT1'C z CO
.. a "!0 ° • ° '° roOP..• C7 awOn ? ie a 5 �:'c-,< -+ a » -na0ve < 5._ -° ^aw , w5 -i ^ aroo : • o