Robitaille, Emile Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Vr 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. gistered No.
Town
Dist. Nell 51 Countya
6
p (If city,give str rise)77.1.4.:e4
Name of deceased 1?
Ingle, married, widowed,
►may
Se Color ........ .. ....or divorced (writ e word). /1e9' c4,�f' Date Deat 1.9 a
Age....,,, Years �( on s Day Bi " lac ..
Cause of Death . . F.....� .�.
.. . ......
Certificate was signed by /n , M.D.
Address i rs• ,ice„
Place of Buri 1 or R m val) J.... 7 t,.
(If body is to be ore ,fi in space later) .
Cemetery.. . ....,... . .. . • .. . .. . . ....,....,....Date of Burial....... .... . . ... . �' 19. �
(If body is to be tentporarily Id,fill nn space
The Certificate of Dea containing the above stated pa ticulars, having been presents to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have acc ted the same for egistration, have recorded it in my Local R ord with the above stated Registered
Number d on thes th eof I I-I GRANT A PERMI
to alp .‘... .... ... . . ...
N me) s)
the to hold temporarily, d the body.
(Und r or pef) hng charge of orpse) I , em ,o otherwi dispose of[state howl)
Dated 19..c. (Signed) --
-- Local Registrar
This Per t is sufficient for the Removal (and Interment or C e a n) o y to any part of the State (subject
66, ery or other regulations), unless removal is by common carrier,in ich c e a Transit Permit (VS No. 62) is requir\
..... �5 n
gv LI ~ Q'8a.n ..Iaq =0; °^F;o ° p`0- rtO7wroom ,4'r�'n � � oo'S:QS •*h5• +* v,
?;,Ag n 5 a-• w ° n 0 xy 0�w n n-�•n'n as m o°Q.n co to ° ,,5 Am A� v, 0
�Z 01 n-'*0 4 01, n w •, pi ,-... ,..M,71s.,?,,n n o"',,t oa ,,tv n ro m cr•, 4.n.''G•^ O r� 0 'I O C Pa rt 'r CI
'T7« C 0 an P aCb +o �' ¢s o '� wow ro w ww ' n aq �. .o m 2� �� �M C•m ro
tp ... (n m n C�...S.< N O`< ai 00:-•O"C �-.O ,0-n V n N-x C "! C .mow.'L7 �p ,�•'*.C`•, a. W 0 �.," fa 0 rt
"17 C+f W manv, o mn. ro mn aan n r.O5 . n X1 di " 0. 0 0
S.
y" •4w.,.,,] a..� r% r'' (:).0 y 'O am, n ... P3 Q .apn n 26.,n a q..»,n , .n ¢arp �'� . o� •� .'9' .''�0 v0 v
i 0?O *Iii-R tD 5"". .-, `' w o .0. r'° a '-'' *o-o Go°v S ,.. •�`.'u.ro m o o ne w o > '� 0
ro t C ,' et x w'-'5 rt O 0 < n a .. n A '" P w "t Z O i'D"O p.,4 °D z
AI ®.+� n `n' a • n a " °� #r°� o -r ro n *v'' c o o. n *� ° 0 HC7a` "C ill
" r0 .t 7i `'� `.Cn � n nand µHnrytoo p, n rn zn J'n']'.», •-•.+,`< n a.C9 �. toAff
ro t" m n W o o � a n rt "b ilD.� ;- « • W n w •w n 0 b n n e"i! •••°tc .ter 1�n
" A� ° <'On NnN0 �.MOaf s Wn, n 0 n0OM n ^nt "g�.5•rnE."�. 2rt00! rli
ro `2'0 .`n•. •EIIi' "i
a. Cna.w• 0_ ~ 0 x»a no r- r,.tnnGararo ° 0.•el cn wrn.A' roto0 � 0 C5'O 0 z f
xis®
a•P4`4 M 0 c/a0,-1 co ut 0 c'''d 0 n o o " o ° r �+ « w
" rP o w o• a, .c5. rn « w PI to
0 .•1°.�.1 r n a) 0 '' z':t ° 5 ~ o•55' -I m ' o-0 n �ww ••;n•-. z ......0 w M w e)i t70.•rnD»a'� .P5 E. 2 11 tno" r,
0 a'ioCo orn n '5,-4:, rn w n ?'.nW Pn'p •ta �nPW '� n ! ro '
itX 2> a� o ., n,d 0 " o 0-•O o w tp C r rfl o of a o[1)
t» n a ]-"-•»,*y''o_ n o F 8 El,r '1n " m .--'' n n � .a'ry w•5 o •, n••o rt ►; .." �rt � 5°4 Z 177
I
O r5 trt w iTfl
flU
r Cr7 ,. cownn � oodfl
..,'•'1 05n .5 2- 0pa "O.m -I � a"'°''RP.On cr. ro ! r ' w� R7 n = n .nr.n n o0 a.cn ,-- C.7 aan c � $� :p1*L
B to ,-,• r. ;c m o AL
ro �,� C r.m =T w �'� •�n ut ,•v A' Cra n er,n, '-0 Irp gaGe o `�'•."...D.09 •.��. 'O r<'i O ..s0 A, •i J^.`< '`< O n n `f.1, C ! A 00 r �! C'• ~., P o �. 0 . f/1n7"
�Hm < s; n o n � � •t ' Oyw n0 ?" ,2 �r H Z ro
"• '7.N".!�' ° 5"y o n n. 'Rs, O n r. n •`+ P. .w .. y m A,`G r m to 5 n W.°., A 'g7 H 0 " '�,
a rt Ry.'t'i r• n ',, • a.P, o ., ,•,� n :s"..n n g n " R ADs,r-+n*��A Z ..o C to C P'O CD sr ec� g .'. ��.1•t�'
M `Y.trlA.. "'1.n , ,D.2,w A, Q.1..,�0 `.' = pnn . Go `n nton <'b 0nr.•,, O00, 0 7'L3 A, 001..--0 r 0 tll;.05 w 1~w
ro tit D'• � OW ,��nW .+,•, `o.� oonNC ,+ � nn •t .-0-0 fD . `C rn C' CA "' yto .. o �JZ iv
'd t!1`,„ro n t7 4,.'J 4 n n tv .t •, •Ar E.o'• 0 0 ,, 0 P.C 0 .., 0 n fL ro ..0 rr" 0 ;.. o'
0 . n •tm ._.O ._. 5'N o,o 0•'t7 b a.w n g a.•o C 0-to �.»M^+n •Y `< .,,0`-7 , rii ro ® c "'i
` 1,1
. n ::I.
n •.., .S -t •'+ n C, n n ,:",0 - o�„ n O •p•° co'0 `"'.y rn•w, �tw •o•o'O t�' m �
x C� �'� w '� "O 7 K7Cn C Min P o nn0 7C pm 1.y "�
zit!"/ �.o-.o.,,f,, �n :. .,b'c7 ,.. to N ,I "t 0'p ,.„ (D n.c`�r, CD a 5 Q'C 2 •, ,..,--•'� p H « �'S"K 01 as V ®
.! O W n C'• `y,. n C"y• ., O 5 n a. :•.cn n •C .+'n ~ ". n O Q.�.p,w s.r r+g «•«.
O ro0 n •, 'o •t tr P ( n " nn c.0 p-o' n 5' 01 0"ba .., G « .. •
MaOro � •, w� �CD � �, Sac oU•o ,..,acilo " oo 0oxa � " o ff• CD ,.� a aL -" Crf C�rsf
t...M. _• n.. O n .. rni P'n "n't n v, 0- 0.,
ti C aA, rt Cfr., ' Z
p6r.4 � 50yo ° ° wok *� 0 5'aN °,° �•n.r�o Z-Ebtn' :?.noa5 � w• � aco,.CI. . Fr:." n a_,omi
« spa, O 0 y ]'n n.5'n ..,n y O "C n y x �C'.O :t ., in' O �,p n < n 5 w� n C='S'C n ]' C.'.:Iro 0.0 _ Z
.. n < W'N mo o•,.. . x C• b 0'n ,..,.•a,v P.P F4 .d rr.�o . 0 0.. - o V1 "•'++0 (/1
h' 0 p. w ..�=.Vn O'J W o in'n �.`";ri• cm"
C''� n,o O O O 4 P. C .0•t_� ,,, < n .+,n n $ nok
Nofm!09
ro 0+ » CD."-.ty n o O n n 5 ro _Cra'• �Q „ a,o.rp .. 0 rbo r. n ,.,< n .t P., a.r CD ro a
no-aa,, n n ,-, nA ,o ,-'"va .g0. xno ., x On
omr•t* • .n, t-hoa.'nwnopa c. :?'o_ oo`..°a•o`< z'•nt r>, a' 0a•n, m`n° bZp,' o °aoc 0,.0 XSX
°a7C; •rox0Eras ; A, n•0own ^0 .• ' a. o ^Ftn Dap-r.�owP.,nwno5•»,C XH.+m a PS'
PV
o c no .A � = *On05 z < o bn o:c �n o .^� 7 0 ;Or �•
O � O n to 0' n ,-. cn omm � 0 Nn n
`! ."" � ,,,o :, � PO �oC� p nr. nono 5a �, onnn nn'0 'ryon - t+f C..
Xi ,...---.:4
,+-C+'�'U AC, P*0.:• ' C].0 Co b ••t 0 u, w .K' r-.. <•. 5 C rD '•n O O 5 0'tl ttl'E`�: "' C!7
pig, o•ron ;o n 5 0•o:n o o n n 0 0 n cir. 5 a.o n a..-,to m y'o o 4 K 0 co 0
w na`a v 5 m �� n '' p".n 00 5'oa k<° z a w o aS m 9 w a ° n, 0 nn 0 0 Ttd '• 0