Loading...
Mullen, John Form VS.8L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT t 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 T A Dist. N ..Co ty ...Village. Y t� ,r 1 (If city,give street ad so) Name of deceased. .�. . rye Single, married, widowed, s Sex !f.�../ Color.... ... ... or divorced (wni te�}ie worcj01�,�.. Date ate 19 Age 7 Years. ...! .... ..Months �..� Y s Birthpla Cause of Death ,, , Certificate was signed by.... y M.D. Address ,.. Place of Buria o al .. 4, (If body is to be ily , i pave later) �iy� Cemete ... .. ..�.. ... . Date of Buria�l.�.(1� .. / 19.114 (If body is to be temporarily h ,fill in space later) The Certificate of Deat 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 ecord with the above stated Registered Nu> and on basis er+ H SY GRANT A PERMIT „...ezzuwi„.„... A64, to... v (Name) G� (Address) the to hold temporar an the body. A7 ertaker or pe n bavi charge o orpse) ,remove,or otherwjse pose o![stet ow Dated!./ " ... .. / 19... o (Signed)/. 1/... cal Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a bo y o 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. t..110 roOw w5.--u.. cnc ° orowoor) ro •, o-roMN w " < ° c »,-- p ytn •...• o A ., n ', o.o'o ° caa G ', ....c »... a re ° ro ro 0-'0 co o S $ ti o � �'a v � x" Oa � � o + w ° w ,agwnogii �y . Oro > o >D M „si, IT1 , o ° a ro Cr 5•.- , co r o •° n „ B n to c-• w o ", o w o H wcmC 5 r sr' •oti , r. ' =, N ao w'-,'� �o M 04 7C� p-q o f° ."� z a 0 o a °ca•a c ro � 5 ° cow :: a o-==,-• ° aB L..+o " v3 f to -o L m ° 'T1 y ,1 < E.< Cc, °01.3 °`w<:D " -'p op:5 o o tD 9..,V^t� H N -, " ,7, o o'00 FD .° , F •, G p,`I y z 9 00 .- ° PO �•"i A r w R. N .°.,,', r,w .F U. °, N•N •~ N C ` a•"•to �'�'OT..'+G..,< .� < •..S ro w N „ 0 M 0.a t1 V O �/ T /r .. 1 y< E ° ro o , w ?� ^.N n p ° f o a.3 ,=too•o 0. tin C...tS N 4• .< .,,•l 0tro, ° a.°,toaoaN ° ° F" o *w bo`N -; < c ....� Nc < w0 'C Mill' o•O .,.a ' CCD x 5" `.0 5 w-o A ° *5•0 oG o v 0 co o. N a w< 0 4 ,.;n 6 A A , � 9 y.w _auto ° ° ii w ° ° wN ^, ° r*?;w �!.va0.H o ° n a; ,, " .0%." w o o ° Poi a•w f. ° .o � ,, •,_ ° ., N o ao 5r*...c o;5'F o o " " 'TA " a zTov .�•`2.' R p. N•'i7 •<-••`t C•+ .°, in m o C n ° w a C ° �'" c o »° F a,,, �.''� •i w a 0 Dr] o o c fD w.r Aw�ti rena ° d 0Na,._,• a ...rT❑ a� •?'. •'- °`a �5. �K R 0Y ""] .oproC + +aNcawao °» aroo " k,b :;,aw F N'myow ?:at, N © •w ( OS :�. A� o d w N ,, ro T. N p G t 5' o co o ° n �o °„N., ❑ N ° o a o �N p rT1Q 7•o d 0 -,.a‘ w,5•1 cD, a. -0 A. D O •o „.' a-ez D n °).. 5° G' `''-'2"aD " N G Q o' g-.* " �1�"r1 n.�`e ri _'5wx• N0 `ti°gao-�`ro 'r -Nc°o5� � o :; ww_w �c� � �',yo ��''rJ ° t�1oR R • lTl t: ..1.°..'4 O 0 W O •°'� O = g M'•M .1 •°i vim, .+C•O*', 0° Dr w rn'O O n a•-.° a. ° is •i _, • ° a W to fp f o, t .-. 3 0' ri 7 ° O•N 0 ° n o ° •ro p `' O O .°, .5.r2 0 y N 5.ro ° .,r„r,t.7•fD y' `� f�'Q R "") ,* p,x0� a 4' a '' �°.. W'�.. ,°, o O'.wco co -. w '-'. o-° ,, o oN °ro 9° = `p ›. o ""l X R ��m "�_cw3 `°° ° CD ron ° - ep .� cpa0� aeC.� ro °or< rDeD o � o � aan°oa-°i ° a £ 'tilPr0r =0 a t"V1 °.•w0 � O , O .1 -igS•5 — - a.bw0 .1. f.roo .y §..g ° 0 w`' ° w0-5• Cron r '! < 04 a Zr. O Crl a .O .a n a a ..w•° A, o V, • z a w 6 . r5•< �.F';5 `c p .n �e,�'" n /3 t'l,;,"p o A� y..•no° 5aaz 01 oNa3-moo , oa < o.o " ° ° ° ,, =A. ,..,,a--_ wsPR �.° w y Z ro ; �.�0 w N �'OwTp°i m 5ro ° EagS t Cs oa w,,E, r, ° w .rzp� nAmN `: . g°w'� A ..0.-30y .d O w O <.= N O'° a rD O ', ° .�.,,, °a.° ry, ....° O• N S ¢ N ro w ID ° 0 ro re r"'71 5 "� eA' a p•�o a•" " ro r, 4W '0 c� r'o cm 4 �i.w ° p .:_®C" B t'� ,,; 3' porrPC o ��� a.a a�,as w a o g° � w ° ° o ]-o =Y o <ro ° '' '^�°° a.er.v °; ° w .r.eo �"$ r. 0 o• Cr;Z PC NN ° wa,�y o a ° ° ° ° co N x ° v' < ° CDci) C.A. r9 W •.'+� a oo •, < -. .. OroroO ° as ° ., 0 ". -4 `0FD "a ° o *ltr1 CD a- ° cr ow .. iilI o.o xtl yaro ?r.::: inU1i `� ""j `, «, ° ,., NN' P"ro ,, °�'gbro NtjCA O13 ti N " 0 T" N O ¢ ro w O '� f5 a •" o reG" q,-, c, c w ° ,, 0" ,, N o o-n .,.;-+ ., ° 5aa � '1 a:o ° ° a ,j a+ dw 2 A n 5row,•, row 5 n ..roogK rD b' r•, o ° ,i; 5'- a" 0... ° 0 R O Om `° " rwit1, n' m.c. .1 .a° NOOp�,oVq,P' 0 5-Po9e .°, R . ° -< oa 'aa ~' ro FOeo �~ `06r� ...,Dr)- w ° o' oa 50].") ''"9 5•" oN05•° c00xg •, Do'ro �° A . ..] trT Z aEafO O � � �ba ? ar"ox ; y ° ° daroo �n- N ° @ '�,ry5•.-"0 Nou o, °`1oraoC� xw " Q .. Pi N .. ro ° »' ° ° N Off. •, .+,N < •, ° n ....n 00 a A • .. ::M0 w :' Y-•roovwow ° o•5:R; ., nr� •caoo •, p �•0 ° ro� ° oc ° -, a•° aP xm.o o2 U .. aroNaaw`+ . 00 rn0-Cro;1ti 'o iow! 1IUhL : x� aroovei o NP r 5 <ao K .O° •, w° roo �rw ,..,n o a °,� - w t a N _ti ow N 'parow `' r�^ W �m CP. A O G ° ° C...p.N �•e C t 5 5„`G `°t O ro N >p rn p -, .O, r, N ° Ory r- `l. ,� •m .�aC r trrvZr. t., Cr1 co COx; 3:99 ... wrtaust aoy wr''o4) 0�-.a . ".N � ao 4a•ovir, ,, Q " :. < ,o,N .." � +� Q a ts1°, 51.?mow ? rSo aC r°n S m P`C °, r°o » y � � 5� e p, 5? w o a 5'w ° 0 .....,0 S ro 0 v p•., 5. 'r1