Hubert, Nelson Form %s.61. 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 01
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
� R istered No.._..�0.7
Town s
Dist. N��,�.1 County....d .. .... Village .....
It f city, give street address)
acne of deceased ..
Single, married, widowed, /O/
Se)11. 7..Color.`.�- or divorced (write the ) Date of 1, nth"/ ,�i�'�O g, ,.
Age .irgo Years... Months,,... ...D rthplace , , tr
Cause of Death
Certificate was signed by.. .... .. ... .... . .. .. ... ---,. M.D
Address ,eil.. .. . .. .. .. .. ....,..... ,.---^�
Place of Burial (or Removal)... ....
(If body is to be temporarily held, fill in spa later) 423
Cemetery Date of Burial. 1
(If body is to be temporarily held.rill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the s • e appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LASS-.
I have acce. - . the same for registra ,�,,: ecorded it in my Local with the a stat Registered
Number, an. on the ,:sis t j ir 'i ' ' NT A PERMIT
to _ `i p• /
r ,
the to hold temporarjly a/ he body.
(Undertor perso haa�,�'n barge f orpse re e,or of ' e e of Es ow])
Dated !� 19 (Signed).
.
Local Registrar _-
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Stat (subject to local
cemetery or other regulations), unlcks removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
` 21 'I o o.o c C °oa a a ,.4 .-g.b0 ....E a- . .. oro co O'er o < o o 0"8:0 9 0 C7x"iv' p'^^ ® Cr/
.'T."1 2 't Oda MoanoS O•5"Mn ....nry rom •- wo -.c - ENO Ory O N0 >� '�m A�' co
4.4
2A'7 c.- 5, a3aa.fu c'oy0, :Lto �- mm *CO'�,N� a .4 ''+crn.,-°-`vc $ 0 . owo ttnS �M,ti m7, 0 0 1Z•�
.--Po U1 m N p< ri < y � 00 a`D y �0• c. •rOD+•9, ro m a[9 .".V^n ry co-Y C ,Op n �..1 ,,0 w.n_ f1 e V %•4 of PI p v 0.. 0
��I�X E b O °"O n ] wry ' m ° ro "� �'���N`• �+ ° 'ao •• <o ° 0 p `,° °: o fDV NrlJ r�.Cvp " AI
0
•<� ,1 �o �• a woad° �, n w� go *w � o � < o �_.ao . o 'o'�< wo mCP
Or za ', n 'oRy n Ft o ., *a'2Co� `-2. 5'aw o � cnor, 0 "IX' ^i
H - -, w n o 5.D., -R w of o w Cr *0.0 p w..a 01 01 CD?:p'.e��.+ 'ao " ° ro f' 4 z R o >e i0
I-0 -, Z'�.e -C (9,•e" ,�aw �5 ��.0 `C+ acoaP fmnnwyw4 byy 40.N , mA �U�iti MM
r. m rt. Oq won a G0 . A ,. roc' 0Onw r) * .1 ►y
>O0 03. C'On Awa.-,a,° n.C•K nw ,- ra 4 '.e a,C m '..'m'N p' 0•� o5n•W omo •."i.n ti " x...W1 aZ
XP012- 4,7e' 5'CY '"i' a tiv' P."L" 6. .C•0a0 .A0B0�,�� O', .-o-J .1 ° 0 H oo .w .S Ip �am7
tn0 C ^+ 'sOq C w ao - - ' N a C •C rf ..4 3 V CCA
a wy tiaA'.. C :. 00 . rows D Orn4"' Ow �,Cn0 3PO •wa•Q,(A »+ 0002
410 ', o •.fi41'10ro •p'.'o� �'Z' " .1pO "o.`-0.. 0.» 0-" ., oO," w �p) " 0C �' C -t92.0 C x r'l0
�d o � n'W -, roa --Owreo 7'. ..nw * . Act xn y =c-aw + w0 9 "Er 'A�
''v`� � ..'oaogA- o »,';� ocom --Pe 'Ao °r5-"2. o * C -11, �5'et> o-; +rierw °:oy K7 »e trl02
xzonwoti z g ~ta-C ., ., zM 'ew •;a o --Cp, rywnn0'a � ...c, ., (D �.erCI ° MOv,
> o,Cn'Y9Mro � a 'ow.rD ° E65 84, °•. A ym °o� ryr r�y �•�ofD, �•go '°rrr`��]• � ^ �u'1�pN o : �zMI
m .Pq y•-t 00. P 0v'ro- ;' w ',• wM. "J O ',y'o n .`52., O^ gr. y oV a_ = r 'e RI Pe ›n'.5 n D c/r
�s° a ro A e°y °q 2...7.1.c w b " ° rD .r+"°C C. a a,°0 p O F ,4e M %v'1 A- 9 r 1 C�-1
x t to F. = .+.0• o .o -, N •e=.5 ,....0 �1.;) p'•O .�.- .^'I •.d W 0 rw~.~ . w Q .-,-.1 �N ....0 < x m ri' " .9+ 2
co jrs a, a ru C'w rn o . re, •w• �G U ,7 � ,,�,7, o 0 .'2'
j. 'j.W' 5'rD •w •'. r9•p'..--9Q <'-. 5•° O .°.,n ''3 0 c.ti 7'O- C -A> O in.-»W ` -i 0'z'^ft n
O ., , o ro `< o'•." o ° w G � rp - o o , -n•••3 a z X 0
11=5" .�� c.7,,09 m- c P O A° '' w a.W g rt,>� .. r^ H r) , a..., O 'P tl iiIliT
z� 4'w0 m ff '.,..."�� ° E r. r&' * * o V „ ,..1
a0 o` ° n -..3 4° 1 a o H�
rri
CA
l . , . ~ •� .. V . ._ _. o .
��•tp �jw • o C r r v•C ry ° aCl '., '' . ro
▪ Cs7 "1 .n O n n =•''' a'o ' ,. , Nn '1rTGprt, .1Y' ', z ^ On� L. 0... 0w ; t•. r•
O
el .nh Pa , tiy ., J e ° rn 5' , C c "dN " � 0 �" 'r.i MMZ2 94 n , ' _ . r y n o 'ro'4 .� a 0 ^' �, � c a ] a � c
,. ` 7n Zr b'O ~ ..'O.° .. v .0/ _'r' 4 „c e -I C p -u H►., . ' Z I*
5, ar.`" ... nnrn raO ° yO O G. G ^ O - i • '' aC) L • � C ►jZe 2a' or w04 o . ona .4 J . •n < »• � •, F, 5,c Ry o o• ° s ro _ aY oJ ° ° o � am" » C
n' 0 y.0c. ` n• . •x ^ `�' •ro w p. . w • w r/ ..'^ r et a• �ff IQ T n-.zw p, .+^ w .+r re n - nA, ' n 0 0 . rC r. O to c .,y < -. r u
(�'O w .- : °". wO t ', - ' .„ 0Ka A m
. O -t o O S w o'm A, .., ^T '. a* . ...fi r' p.'�'' ' y' ! r,Cl..a;,Z Z 7' ao 7c C. - C ,- .-.r'. 5• * Fs'° N . '•t.ro 'D w aye -A ' n0wO '
*G W ym ., ' < .0 . O �►� ,^w
O(o - r.o ^ n•�n •-•5'3 °n 00 `.✓ [ ~i F ° n ]-.•,n 'Dw, am co •tO f°n. q+,,A POD ' p' ,M
3wC n ^_. ,- w r .CK w_, ^ ° . ,1 o w a.' q
0 :et (D b w - G 5 tn-- ...0 › •c ° 5.••- ::- •-,' tr- .rri
--et G»• . rMo ' 3 . ow• " . 0� ° 7 M
- 5 { ��,: a .1 6 ,0F, - m $ 't.wp, ° o* , � •,1, w " e2o'0 1�I' co
, •.rt 1� �.O v a w :� .; � . e1R0- n'O O `
-. G O ta d m ,O , d . Ori 7'•- _ S ° p W ,_A* ' (
t ° n'Rrw.m n m ., ._ uO n . A O ..• cY p �'a m Z m . o n 0 p E.< 0•Ow