La Barge, Georgianna r
—,rm%S.bl. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 N�o. /�
Dist. No4 7 2 `/ County �0L-Q�(L t Vie l�ne% ..2 0 )4'"`1-Qj ,... Q:t/t" &A..A flt/L.6 .,..n r I f city,give street address)
Name of deceased �d.9it- .. . . .... . .........£..
.0.,\,:y_g
Single ma,. ied, widowed,
Sex... 14(.•..Cilor.... t ,a .aiv.orced (write the word).-) Date of Deat 3 19. 6
A.ge..,.I / Years it Months ,.....A , ays Birthplace
Cause of Death —GI NA...& '
Certificate was signed by 'M... ` M.D.
Address .. . �4 � � �•
Place of Burial (or Removal)
(1f body is to be temporarily bel 11 jn spa e 1 to )
Cemetery ........ . ... . y4 .. Date of Burial 19.4.6
(If body is to be temporarily held, fill in space 1at )
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, don the asis thereof HERB GRANT A PERMIT h.to , tl,
(!� ....(r.U. .
(Name)
(' ddress)
the to hold temporarily and `(A the br.dv.
ndert ker or person baying charge of corpse) (Inter,re ove,or erwi nose of[state how])
Dated... �- 19.4-b (Signed) .. . ( . .... E
,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
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
,c;
r±r�4 ^rovi " -'-O ry^ <�'''= '^..e' »».».5,a' 1-»ro p-X ,- '-•n io ` o 'ems'a 5 ti.5• p .y�. �-.. d ,
A W R a 1 w �M„ 1�Q Q�f, a» !o N ° ,'pD �". W ref
o,,>B � Zrba� w � ., = P 3. ea, = ,n_gqcm •,o-`•i ", .. 3a'--tiy..o ° '+ C1 ° � C � D� ..
ao -, ory � �G 7C D
Xl z w *i w"o < d 0.5 0.c,c CD N =,W.-. o•' ;- 'N 2, O n v, w co w'�- �c CM .. o " R`°' v�E Cn •o w p IC
D 'T1 `< 5-< 5.O 1 0 w cl 1 +'O GD Pr?O �T'.O S.°».W n- n 1 1 c w'�•;d 0° G•-P y aaw g 'xzD .1 0 p„ 0 V
w112tr' Na' w < y °a N .E. .. n nw -< 0 F. o°? oow1 ., °co °'aw .uux 00.yr.m 6 `' 10�
.I D X w aN °....J "n?,, C N w N n0 a 2.�< n•0.. �. n•0-""a...< O < G tD T N !D T .tiV0 v 0
X 'oc .noG.° .o oaN °' -, :, wwA NN wr, < ° f aa°, noo Ill • -- to
°.1� .417......]
I �� " ^wo a Q .f° o � a O 'oo - ,:-.n• N oo .o < w ` o .0>4 7C to
; d_ D.N•B. K c•c•1 O O -' D O < C wp O, 0 z.,,❑ .0 5-'-. 5..� ..1 -^.w p„O .c-.`C rv.n N y O yda ."tl�
�10»y .e 41 ,, ,,,. =.o7ag ....< p' 1 ° .,n : p wfD ° wNN .., ap,,,b �.»� ,ta,., 8 �7 , y ..,.<0 �3
D �'"¢ CJ W °� ONa� R.�KOwy rD w ',�al.
�1NO AO ° ...+ , rD., `+. Q N•Otz ❑ Na '+ DnW>b �T11M
<' .e w .o .�► �• a< �'Ip w 0 n O .+ '.+,A 7 a z..,o0 4 Ai Z
'+ a �,''o L•i 1 N y n G -, aw,a E ; G .o w w o E �•'+ 9 ...- ,, w 5 a o d o ,,,,
D X V �.., ....e n' a Co.0 '+ N c:• a...c o a 3 .,-, n<< ':..••--0.0 - '-7 0 0 g 0 1"I
0 Ul0 C w (8 ^ rDa A'„ay .°..O 0.°<' 0 cp 0 n W.010 p 0 y.;14 uni O.1 z '7 n N W C 5'W -C+� �' S a
'110 z -, o .1nbn •=b Z 11S° '+ a.e-a. R o Nna, wKooiE < 10 CyG Gp'O G Z ')OM0
ti X`w 1 .D - ca fD N N O a D m to
D O:.d o n w... 1 �' o w .e o pc'g n w D � o-= � N • '*N .'T. a C ,* '=7
R.M`< tl'1 -^'• ocX N ° ryg ° 0- .0 K... •N-o5.... ,.onppj . w ,�'i . 0;"n•c'w -° w'"r1 ..Dtrio.1 . ..
ey°.,.-I-I �nA'0 ""+ .°0 ° 5z-1"" N O-er~ WHOP' P, ��O1C.a'.coD.,._,, co4,,+co� rt tr W (aIvR M 0V1(
a 7'N... ° .0 „0, lu O "�'° ° 1 N 0.co D N N 5-2 A 0-.n. N 0 1 „1�... ,a g 1,-- 2 tt'I/
0.'�'"�,b O.ti 1 0. ..• rfl O .w...w k S. ..1 %K 'l7 O •n ."i O O y R'O asn"5 ° n NI, D2 ya'•1 n 1^i
tD m0A wO .*I- " -n.n7•ftt
w O ...CDfl74" CV -Ia.h 0nCr 010•DmII1
fpn � 1Nr, C.� r,,o 1 ° as p, on-a „►.. Snn ° 0 , .Q °, 0� � a;.0 .c ..C = aaw� �" � , £ . tr N OM °14 q ^^5 ,'C- p,- F%.0w �•n �'BO A, ,w, --Gl a+'p�, c'..rf'.��cf-, ''.'.0 .0 '» ^aa� oo ..c �, _ °.2 _ P. m �a� <.� - R2^�'0 ^co
» CZAAZ
, y�i a':tea °. N4 2 .-•� _ ..}1./.�_
C 0 y C' < �1 1 W w V-`, N [S r`K�. �' a -'- N A'�., :� N c'i<.J-��" `�"_� �:G'T,/ A '!1 y p •. ...'0 -
fp-
-i7`�p* O �^ a w 1 ° a ^ N n r , n -Co [D " .., "I n N o apt �.,t' N p+ . •4_ n M,.q/N
''T1.�'O' a'g r.a r N^i 5 w a C' w w ^ C ..•0 ... 0 0-.p A R..� W O D c in F z .. /r
R 2tr 2.. ��a'o G•D�a'w° °.Rm� ° o o 64 •G, o n c r' .<o-• _-^w 0-G°4-c, q .�"..0 ''C..� n-V;; c a Cr/"I"0
t+7•rn ro G �. ..o - ❑ �.ti ' nv y s y ^'1'µn c -. .x, o . . 17�gpi�
CA
T N 1 .. ' °.,'.'.y.G'n 'c R S .-. ('.p^J .G. K r ^a, n O `7, `-ra .t G IT 1 a 7 0 OG '' F>.i
�'m .w-., n N Cr ,?7c "I. ,- C ° N Cs'. ".-1 - n O C D g o �, . :4 p a' , n `7
04'-.-. Z"r5'.°..N ^.'•.. ''' 0.N. �, J N 2 ,..-I n G a 1 C ,.,;!o -, O _. OR O .. a to O.ju .a.
5'ro dp a -°i =S1 -' ti" =1 •n•I w j ism ,•-.,',o ."I1 c'n - 0.5 -' r1 0 S..:aN �''' ^ I.ol G a ...y t�M�.'
�.0 " .I t? io w s- w" �.a O °' D b w ,-, .. - .i 0 E. `< 1 G -'I."" •<T Z I.,,
r o .� •ti n.°-� ^ J^-u,'D N O O �.y•x .,..0 -,1 O .?, w •1 .w -.0-e) ..D ?T "']
s E r,; N G o N o 4 " =.,' '+ 'o oar.,, o ti-n - -I , c n a< a 0 ^�< r= - c n LA �.yr w VlZ
eam o° N �� ca= � � �° x � �d'�a �; o N2 ..-..'oE -oA, � N ..._ ^ c, " �o"v0 A
.. n y N ..7.2 n fD -_ w " n O G .. 1 fo '•^N < .w r' r D D a
s.ti�O w W,y? °'C .Ji N z n O'co n K a.0-CD w 1-1-, w .T tr: n O a:j W 5 CD ° <• �-: . a`< �
i R Z G'O CC�,'• r _ ,• ,w. 7' .D 0•C'T°C-`.O`< Tro -,,, t t'.^•w "�' fD '�7'b R E.< ^ .-." O ...I.w
0 r, 0 l0 • 1 , r n- r', ^J++14 '„-'s 0 '-h a�<•< "• N 0 a, 0.e*N ,- w . N w '' c '.-' ,T,,...D K
",`.ma
e oft, Co = -... '-'ter o•O R co a- O1 O,c a >OC n C -1 -°i n N t9 ti n'Z�'0- T -'! ill D P. „"` DI
1 � , oc.-Gi -. � n <� = r n ° y1 awN � G aluC .:i = e 1T1.'pz 10
� 00 „ .� = � n �w °� ' �N-.'�< ahg �'c KA �b �N �•°,= = n, , DTdE 0
s'l�1°,. m�'w � ioo� � 5' ? <° a »•°' W.x, oS'ooc ..., _ 0a-= A, , wG•O.; G.a°� XJ 0