Messier, James Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fa" 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 IIN�DURQABLE BLACK INK. Registered yN,o, 11..._..._...
Dist. No l�.. 6
.2. .County.W,lf.-�1a . 4 Village..a E��4.44I''t✓ 4� (.7 •
OL (If city,give street address) U
Name of deceased i
�y • ngle, married, widowed, •
Sex f Color divorced (write e word) Date o ����yyath .. .ar....19 �J
i,/ Days Birth lace` % sJ ''' . h‘7.. ,
Age /Y s..�.}} . Months
Cause of Death.. . .. "'
• -ertif to-was signed. by "' "" r4� _ ��.... M.D.
Address i 2'Le • I,.
Place of Burial (or emoval). r(.
1.. . .4.. r..
(If body is to po ' y held,fill sl��late
,
Cemetery . L Date f Burial 34 19..SL.f
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated articulars, having been presence to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUI.RED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Numb ,a n on WadiI HEREBY GRANT A PERMIT /'/4hto t►/'. .t... '
(Name) (Address)
the..... .... . "- rr to hold temporarily nd...... .. the body.
e taker o son4 aving charge of corpse) (Inter,re ove,orgerwis isnose of(state how])
Dated 1.7 0t 19..(1 •45 (Signed)... .. .... .... nf.... . g
,~ Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) f a body to any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier,in which cue a Transit Permit (VS No. 62) is required.
e x" O'`%° o so'a � op a -, ...E.B ,w..,°,°, o• C"O e o n N7'� e •< o e Gs?:9 a'� p�"gy p^� C
ri
n rp Oa• N n ., w .....w 0" °W w non a ° nkNOo x >0 > '0 Se in f!'�
..'z2, o.0,;I ce•ro p.o n 6 w -0, w�= P�•?55 3'04,z, •w•n+ .4 n ,y. p c.•O.
a ..1 y ° ry Nr� P� 0 fo a , LLi.
w afro r. 0 a < ° Sa°-' f9 O rD v)�
$p « o nCl.oa9, , re ww•n.`0 •* wr�tvn rpwwrpww a.•; 'C wore
2 � < S< 5 o , n ten , :•o•
OorT d 5b orfp w n , o a.., in •p, v -, aryw ,°� 7pxre •1 0 C. », 0
-4,,72 2 rri �•• rp yr w < y p '°, N` o N.y :" - n ,,, n,,].a n•coon o..:..et..
• C O�•my 0 o w ° .i= a•a w N a. ^a A " 0
« A ii" o " wo w NO on • rro '''• n• n0 a» < a < orpw ,'N n o-" ,0 ..
i`� �C .oT' a° et o aN w ., 5 a *w co Nm -fDi < g aaaa ;c ry oro car M .C..d
'G cog .n 5• n n a o o to
'-I n E.a rn•N o rp < w .a" ro to
"d o.0 O"y° rwi .rD, a N w o e, rp'row p *7 O Co Vre . aw o rD 0 ~.R a z•-1Go "0
0 3 x a. x B n ° a .. W.F.A. .-'.. n<< H o
ox "wr� E w aw s ° cwo' * ro " n n ., N.wao . n cn>p r.N a y•n n ro a ,y ,..�n N !l o w n N n .+, v, n •, "40 "'.0 0' ►y
•1 0. .N•ro <•°.o ni �i t`n',, •, n ,a w G re 7',°. L< o ,,- W' a O --O ^w a''"+; 'q 0 x•1 (
O V '.ro ce o A ro ° N a C• •n.'•.••G'o a g. •„A) r••'•.n`• �+rre`< '=r.•. o•w ° O C O ~H
•c o C ° °dq c a ao ° c fD r'rD a o 5 N'7'n a o ;5 W''. 4 'a to
wN .,, o•... 140 .. w nNow ° "' w a5 A
°','•'gad o �x?;»`�' r� rr� a =ow �o "' p � ' r;n � " ] � nNwwE� r<w, y � c-.y•ew G5'Op ,°, w ��G
3"Wa 'r'5•"crQ x'-' w o .n, rro, ° c°ro •C .g'$•gx gn w w w C5-rr,, 0, p, o w ao N 0 on p^.t<l90•, rr1
a•, rpE 0 ... y Con O , .el • ° a° --c rp »•y w 7
pr.]'°'^.j n�• '" ?• ° f�p B rt° ~ N N 0 0 N °'•n y ° a`'.`°p,K .�. ? ., ° K,mr N A •'0* Fi O fJ�
xx aw c ° ro• o K row 0 ° 0 k 'r CA ,•, N "'5 n n ..,crfD y' ,y n ° o n ., oo "1 'or F. az�
A. .° �R . N o w ° • .0 ra o ° n p.,;• `.[ 5_ >°'p n HcX
t1.[r10Y� '4W ° aro w :?, ° -••n n 'P=w � O °',�'n 'rp " " a°,.... " ro ~ •t w '�' CH
•r [[++77 re ^are � nre � N � noa no ° ti n < nfD na° wow C!J =0-1,e . 5` ►•�
p '�"lb =-;cwy � r' onoa.r°p �*n ro° �d° �Cn W -5rur'Cc .° ° �Or% r�•, r, � g $ ri? Er ^, . 0=0
p to w :Lb-C ° ° ran �o o^ a x w ab y^_ o �.� r.� 5-v f �' w `; p;or E•= $s n i 4C 3 t 2'....
UJ 4 a '�• a,+w :? c'w n O N « .+py < '< a E.►•. p. trl..."0 ' . to A
►q d o.0.Arw o'N a P a O .7•.•'•..-.•' °' y.O c O w o oo N `o•< 0.. 4•.7•w d '•o• ✓ a. h�.�
p O O.f 'w •, P, `<Oq ='° ° .n.n7• to g.,Nw,"'`nSi o w ?o R w' S w H 2M W Q
n (A w .y mu' ° n •, O _ rp ..O n N y NN-O 2 'Z'1:1° K M ,
V O"1 e0~. •"Y-w ° <•.w-.•'3•y O a w o n o '•t ^fit w-•., nf1.�i .n .N v'N `S',Nv. C N ro O Cj T O O `� rn n �'
rt"r1:5• n• P•rro,w w C • ".Ft O° ° "" Q. ]• n' n w W 'd 4'x p .n o „..° O o-7 •°r G•w O° a:ii.rr 5 t'" "' w ►Xi'.•.PI
° tiny.„, O•x -, Kao p a W ° •C0 5.ro now o•° .,..°„nryq rD w o M�M th
r"r � ,. rD m'N 2s•�.M ray .,, ....•i P p n n n 0 O cNo rt'O ° �• 'W IT."ni y'a',�rrop .°..° r�iL� A »•" O ;'• • �. •M�•�
x Q. E. w O w ..�rD ° rW�'" w ..`< ,,"o o -I t O O R o Oh O ° O H 'I « �.
n C C o a w P o aro < 0"qo Y O,•,1° r..,,sr '� trl o A 3 .1,M XI
o1�1.4 � ^ a.x, ...oya•° � •� � Cu, u, b•o,v � Nw ° a::."`A, 0a -wi r� Cry0a,y p.Vaan >EU
g. <a -'� wry ° p ro Onti c E .< rpN rw7 ° acr ° » ^- o H � ra A
< yryil ray 5-O,yCn =".2. b • - ."FN ° ra 'N•niac •"rn •' a c rpoaE•p•r""e En c.,Mw'" YC Vni0
O'°Vn -0 —A, 5'Cw'w wa" - q ° ...00q .'4.'4 " ° G---
nC- rt ,°O, `.•a�•o,, rt ,, H EEar"*5', v +\'' Mini
a --.0• ,< '+ w rp ry '•�ro °- a O w o ..ro n w n ?rp '+ rp 5 . `< •t 0 p P:w y D'n tp c R'f, ,f ^Y� ,P'"
.. r"?• ....rp n,' n O O n o K y•o 5•aN ,°.° •e,N'r'p C%r N ;? •r O a 0- .w, .°..5 y tr•("9 p,.." d.° �Vv Zr
O E r'< N 5 O N O rrop ° w .°•n�t •'pp n o' •"O •,..-s N ° O .•,o•A < rp rD w.GF ro o f/j o-'j mow T % CA
7 O . .....a o aa•'.t n w p 0' n N,b ( w ° w w ° w M- r*
« Y.• R �N �y .+Nnn "��.r°p � � w�.,b rpo° ° N oo ,..1, "^vi < .,, •yC•� •n�i0 1.40.11 ; 0r
'•''rw ° .w•. rp °ro W O N C L'. • '� a rrop .°e,',°y 5i ..r-X•. O rroy rp o C rp ° a•rm.'e r ''"�a O, }a` YW�
A q.��' a.o n rb w• 0 W p•a a w.1 o a• rp p•rT n, w o rb P w ?: P'•.G.`�D ° 0«ni ro o °..'.•C °,° O C .-1•°�'+d -1 v '
OR0a •' ....orO' . n ,*''' o0 . °,p�`� `G rDJ't°n g•n *O P.�y�' „, nn aN ""� 0 (6.. '..'r.o V.
•."a X," o'•o PJ...w N 1✓n'Oro w 5` •y o:M ^` C b•1 .,,, ,N O K - a:'° w '"0 rr,' •n
C � 0,..(tO co G...Oo.N "'^� O� rp 0 a`� •°, n ro M >�rc p r°p .°, 0.rNi, ri O n•Z •�'OO n '-•`< tTl C w �...
Y CY ron '+CFn < O n ,, O•rrnn ° W sEN < no .r°ycrO o•p tr'g0 to
•n O� .»c e ?' ° .° c•* b•, N w .n aH a •Ci f° a v 5-0 S o n * C�
n• y O7'+��. •r a.--• a p N rp w ?'° r..<.. a o ,t a"T7 rp °' N •.+•.,'o •..° ^'� trj': - 0
A 5ro ?'• rpw5SHc'i RA' »:H .w-.•r°�p15'w ,eprra.<w.•oaa•w9wf'.r.» -ftt8argr0 � �0 '=7