Murray, Dora Form vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t2r 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........_.._
nn Town
Dist. No County. .f di' Village �.��r
_!' or City (If city,give street address)
Name of deceased oZler1-0-- .. . . ... .. .
Single, married, wido 'ed,
Sex 5 Color.. c or divorced (write the word)... Date of De ,. y ../.P 195r„fi-,
Age Jrrr Years P Months X-Z— Days Birthplace./. . —47
Cause of Death
- tifteate--was signed by . .. . .. .tin r -- M.D.
Address L . . . .. e •
Place of Burial (or Removal) G��� '- &''-
(If body is to be ten aril aril held fill in space later)
' Cemetery G . Date of Burial...1� i -. :Y 19.:2etk.
(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 on the basis thereof I HEREBY GRANT A PERMIT
to `�.n..... ... ... (.' ..._ ' � - -4-
( a e) r. rem) , -�
the to hold temporarily and -'ter? .. -r4 V' the body.
(Unde Iirtaker or person having charge of corpse) (Int remove,or otherwise d�s�ose of[state how])
Dated..; s.4..f...,.: .3 19. 4 .(Signed) ..ci ....S ="tu
/ 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
eemetery nr nther revulatinnsl_ unless remount is he eoanannn carrier. in vrbiell case a Trunsii P,.rmit (VS Nn. 62) is required.
t'•H'o Oo w •+•w �'s 4 : wCr, Ogvw 0 •0 r, t-,o r•, v!
• 'ny ', Q.O ° 0 •.' rii C. '+....0 "" r n p'O . n < n S�'C':C _'.-,— 0 a-�N 7^^ ril
ct
xR ° a- n < n - n ., � gip, " ` ^r wno43 " nN acoyRf 'ti a
d,Z3 f► n45•8`<a; .w t~u a.C vy fag,t °y .."PL ^. io �St�o� 'w•4 r' < '5—'� �-17• =r ' n .. ^ c'z'' U)E '�•-• O'm5 •
x a , w p -, C.= a.p, -, n :'O•Wpyr.O .,yam 0 waing :I— W r: _, F.:c .J .-Oil W ° 73Z, K ° C °
T a V1 m 0-< = .9. y n oo'< n w , OD:7= �? O rt...V^y n -, n C '1 tr; n .,•, . ^ ,,. 'C C ., ','V E R I. i-.0 17Q a" O
R."tt 0 tri f D w r O_ 7 r n n n a'p, cD 7 .. •n ' T ^ C ^ CA IM.,.,,m f� w ., `G ^ h.1
'p 't-a•.-4 �'a =o y --'"'n ,o a o n n w �a o •O". •s 8 1:18§ 5'.K•'. v' ' < 5 ynt 7.<-' o 4 ~ '0 x g 2.�.1 p 5' .. to
0O Z ry -4•,a:,,?E 5.y"'- w .•, .O".,< �-C wpv ^•gv05 .- n ,.. n Cw`•�.a-O i° n 7 n'7 p °w7
0 Uf _ -, ° a.in'N v •� fnf v, A•p 4y r° v, �'R• 9 w"'^`G C•,Ci a',0 O'' - ' ry►7�
s C"° W n GO4� �'7 tni � a.� � v A ZH� ��.°.,� g � � O t, 0 _. n W eer, -,�4 A u, �:� R L�NR tt..... - 4 Z
Sao ov 0e celm' ,, o •�'o f° w_ n_ •, yo Qoa '*q_•" w5• �•wo `" � .,(.) 42z.+,w
7 R. y'Ry < ^t C , CA rn'!D C N C.p±M a5 f" n r. �w .^,•h.' a.N E r+�^t r M w O ° O R 0 -:
• ''o n n'0-= ,rt " n • c� •
a.C n� w ., o 0 y o ^3
c Lon, C -i-IN 0 0.w 0-o O O a-..... ,. n a 0 N•P'n -w • n y0'0-o • a 0 tp 3
o ° Z •wso -, n7- �' •D°`< a o� o,n, ° a,o or,="L" xAR ` pe' wa ° ° ,7c ° nlTl
riq•pa-.p p o w'w-fi o.o •-o w 7° o ?''" p -, r-°-, n Ft,'c° ••.�fn° =-t y *y , O• Co'O4� �'''"r1
y.pV,' 1T1 ^^3' 047C wO •n,63C0•O .`•.'fSo ili 0a • QKw ,_� —n A».T'0 w`.� -,nrno K n. 4
0 Fl-°^Fl ?n t0" X= O 9 p x^ o ^ H_gat- , co-n ate• w ° ^ -- ' » .^ K n'u�A rt o•: c�i2to
tr
p n 3• E. 0 n C = ..•
n ae. O -V O x -I o 'n to, w rn �.S n " O'ti v,' ^ R L! PI
+ p 'oo•f� ^•, ofoo V °'° c.� ° t ."ri e,5 = On n ;' n 0--., .. p r S O { ..q '''. `^" i •a3 �w c)-mow•-" —• ron p'y - mF ' cv�•� r � � Inp ' Zx�
e '❑ = Q•c°�n -, w < w a y ° *r• '.• GG - =to `-s' !!! .....2,t+7 .. x.4 o tJt7
a "'1 U7— 0 a. .D4 0'rn rt'..w"O^ ...04 �.0 0'0 n., p C n ✓, ,,,,, .. -''. n rr r 2--,n, n r,.^�-
EO ZA° E .., 7.1 w w w g " n 0 W 5' -, .., • 0_,''' V n y G v €%'t n v ... F. .r..°+s> i n R7_7 g %i' >w
oo' o -, •". 5-'.. f° na, w o �=� cif=ry ; �� cc ^aC" ! qt` = �../�
^'ti+.T.3' P-,..04 a.C r ..A-, .. w a-n n �.O'a .-f•^° , p V ^4 ^,, ^ rt fri n ^? m • ;:121 E Ty .' ,.' -. tri
1,7>" �'y u; e) M c.,."o M '' p n n �' c o ^ at <b =r. 'z 2•. 0.c^ m to I a. Z.�
4 Z�+.. �n S w n .-,+ i�., O O O f° w e n -, • �.�-f� GC T' C o n a � .1 M ; ° - �" f,
GtR 0. n S?. -wi n -, n rt v 0--, -, a.m'P.,•-• = add, .p.' 4v n y T.,7, O^ ,o..,, "•. O' 'e t'7 N o ".0 ^..
ill 7t• C ...r ."O ...'m .. n 0 't n'0 0 in �' n C rK n'J rr ^. :, ..n .... ° . a tD sir
~y t!1 U'�' .0..-n"' 5.7.,N =aa ^ ,� n -n, -, '"" ,.n °..- C n :, f n �'G p-f° rw y •'a' V Q
< n •:.• ,. . »•3 n y• ^ O< 3 A a. • m •-, .:n S Q"0•94 =,..-, rn :° to ° a w
o'fz p•g � rnti .; -= Y T.'- n▪ ^ n•, a, 0 ...(W 3 ^n .^+ 0•C Sn ,4 C :O'pnn y p, M04,
_ = __ e C C�7Cr
a QOR Y; ., p ix �r J.a V O -- w.. 0 .'•pW r''
n r- ' -niR 3 `%� ° ,,.CwHam+ cam° CT
�` .i,r rn .: '� n :% '} O' 7.0 -�' �' O � �' A �•-°•,^' r._ rv.� < '-...• $F ', F _' nn O.I�a�y.].A 'T° �2
w g >f O ep' '4 E..g •^t' R T f N N 0' -•'`4 v =n �•"wq • p " „••,,-�.0 "0 -, 0 w .p" rrri. co Q' "_p� S to Oct _ *'
rr ti.Aw n . w w n 0 7,•2 =..»n' w •n Av g 0 rn 0 ° •c 7:1 a•b ^rr. . ...,fi r^- z a.^ a.� • • °' .. Q�
p° w =. ,...yo O•C °,, C m ••t pp O G f .. .. n —r. ^. -.� . 'lc< M
tr A f° Z ^:, ...r 7'n'''n C »."^▪ °. •O 0 0 ,< 8-p`5.N N ?,. *.".-G y • �° -r•'s v F` C .�- p -' O�,�i u-].°w Q.v
o3e �0nc°•�-t re T�rokn na-< " .0:4, a- Fo, � o '+ e, c rtwz-o+cry »b tri.0z to p7
qua 7•..C+"'.� w -^..C1.ya-m°" p, n "w, "<• �''�' �.t0o < a'o r:9.cN 7.•^.•C Ky. ^" ��. ...0 O
a h7.°. n'�?:wa ? ,°oo a, 0 m P'ae � n »:" C•� O0 5'aq ° 0-- -.•0 0 Co I 0'O.-fDi l p.ry 1 � �o' 0.
f