Collin, Harry Form VS.6L NEW YORK STATE .DEP.t"(TMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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 CERTIic E OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town egister No.... . (} �j
/ .. �
Dist. IVg D,I Count. Village .
... .. . or Ci
0If city,give street address)
Name of de ased... .. ..4." 9, Veteran ,r
gle married widowed G (1 'v gran, give sme of Wu)
S Color or divorced write the word). Date
Years.,. Months. . ./../.... ...Dd.ys Birthplace. if
Cause of Death..,"-
Certificate was si by.. •„ ..i fe s1.1 M.D.
Address.. .. ..
Place of Burial ,(,or Removal)
(If body is to be arily held,11114111 space 1 r) 6 �f%
Cemetery.... _ Date of B . . .. 19.. ...
(If body is to be temporarily held,fill in space later)
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 j•ve ted Registered
Number4 t a�d''on the bass` .ereof/ kiE' r leiT A PERMIT
to . ::,// �- r"':'� .S x .......r:. ? .
the ,� ,. to hold temporarily an .. he body.
Ore g r' �qs q(jrDse) / (I em e, r othe se a of[state l)
Date.... !. � . ., 9. 7 (Signed) s
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
a s m I cemetery or other reulatinnsl. unles re no,l I lr,nnmm..n nnrr:or ... ..,h:..l.. as T.......:e P_.....:a !VC N.. Q9\ .. ..........1
-.iv ro o a :to •N �.tnc n ° g w o ° F n -+o •, �.o •, Nary < n c o ...... d "4C4 •,�^•
; X9 -M ry g° anr�e4q n c n ".t.-, - - u x-O Roq w r^,03 G:° .c, ry'O O o ]- y aM p ift
0
ry ry n A c•`„r 4' -" r, ry to ^ a '° •, ^ C < o�a9 ^ 3 ^ c.-• w -, o �N �m,c wn � s��CO., .v°ry •, *. 'c.•o `w•'-, ° ^ 3 ; NCO, •C 'hi °2:: C.45 <ro0. na.gvN ry0 .-•• a n a1Nn = rt `t ry•• e p^g4.'.On ^ NJE �"0 z a w ° rya a.w ry n ;.g•wp, o '„ro c.° wr•- a n -• ;' �° °= w.o o N. ,'J ry E0- ..w o X2a Q,D17ywS 00 ^ O`<:Dw O03rrp= W ^ ....V^nryre- a ow ^ v % a
0 n N ry N O H•N . n n co.o•••4 rr 073315.8 a .� .0 n R 5' a to :i a. '�2 ° 0,.
e•`2.° Ci1 D. e.', .°•, .n w p a wan ry ^.< Q,...1""•• w. ^ ° .f.C...< 7 < O ^ •ar N p^ T' +1 0 v
+"1 k n rD ° ry ° a ,, o ^ rD ^ Nry w rD re .. a0. •s.^ ro 5. .CVO
: -<':,••� omega° 5.o 0.N n ^ .. w 3 0 •fin o o N '..ry e o .n.^ o o ^ < a N "O TC rb to �
. ►y'w �;.ry3 ,n' a9 „, w� aew ° M «o-oC0v^ ,.��',_,,,, .w .. " ao �AW ° a`�Ca � �Fytil
o.SrO N ^ gri, Sc- B ° O c VLF w ^' a r:. 7'� a.'.'.. w G;O,`e', nn.= " a �. ��II '� /:r raj
° 2 0` n a ^ E na . a •• ., < e ei c C•'o O. ry rD v' .. i .. •
e O rt to ^ .-•,.•ry .. G(7.^ n•'� O. ry n " ° o a ^ N ,r• S.n.p: H ^ •, v "e
� r. ryZ cep ^ p.m awn a 7,--g - =-• • as nn a ^ rt ,yN "�v E.
Q° C�N 1 MC17
C I"' a r. O w S c A on G•E N ID N ro w...•rC " N ^ ° 'T r. {• ••1 .a'F y'�;,, _ " y 'y x ►�y
p O np 'C rD E.n G.? O S gyp•► �• ary ^• _.O A.e N ^ W D O �' .n.a-.° .*a o ^w A M TCi Z Z
.. a Or N•ro ry c '^4 'A
`N•^ ^1 2:r M i =` r.. ^ a T ,< `� 0 •T•"t r •1 0 H o ° 1 "'1
2 NA C -,II 5-"A a o.w a.0 o c ^ c_. ,„4 „'ra.w 0 'a N'u y o a 5-a n N 5 w c ^•4 5-' rA 49 A�
•.� a N ry ^ •� N p� r.<< ',,• y ° rp O°. M Cy •.71 d e.°,.,�w.."'1 N' '.7 N rD •�£• < "i .7° c V"'i w+ pp O r' •Yi Si:
y•*1° �.. ry O 5. re at ro ..Z ry ry ry..G.•-d S ° 0. "' "W M
O one. '"' ryr° 0.� r° wno �' rew ^ A ^ ° O*S^ r°.^ N0.;N5.� i �r3" 5 ' �
.7:4 M...^OqX.' N ° MrdD S'+'d �. O �.X Mw ?:a W ti?i n n»'.�.° w.. R• 0
;0 a ° M o n ^ Q ° �• n rn a w n o O + < 0rn
0 a'n 0.., M, S� O � ry S•oi `1 '1 N C.n*ry �^ pr aryp •, .3._.Ac.P., � i: •. ,.r". 0 n,� epu)° 'E �... 2tn
rr��••T"'� re =• C O n ,� ro w•,c p ?O O .^i t. 7• ° „, N 0-, et tJ•..,,.a y•C •�, n O O R �/�1 R ..] a �] 1�
L W^�. a, n ry •.�'Vr..r•y'b,. M .'? s'.w K •ry... •~w'� p,=-^ l' ry 9, O ° N fl: ry 9 = 6'1 >0-a A e. ^l X
o t°7 oqp °- a n•° M •-•a n 7 ,_a n nZ re c ..,� 0.,° ^ o.V ° D..•
0▪ �O;O �•"aceJliilgui
�b � wN•w 0.al5.b ~ ^ So v r , M v. r''1IilL11
p'y n4G •wr.Q =•.-4 `G C rD .~n..¢ e A R.(T7 -. oN,r- n r"0 •. a_._.ov N °- ; = r ^ �y=0
•: CALL n W '»H N n ^ ^`!0� ?" ry P' ° ro N N �''� n N N ie ,,,�' ° 'T7"1 p p
A O a � cw O < w •m o'^ 0.n rt o .1 ^ g.•, Q.n "" .^ v' `9, C Nro fl.p, 0 C. ` PZ
►1". ? 0.w n Fro p n , ° p"�• •..•
'T1 Fr p ry `•n CD , Gary w .•
".'nx5 ^ .0.^ooat c e° g o fppE N r7p °*° c� '^ r°D `D ^ F• o ° 'o �►�
aM '� SS ry 0.n • o ^ a ., N•cr3 ^ ry ° < c Rnn�?.0.cro .1 '1cp (/l .° •" M "!!
Tx �^ NNaa -.DI.,y..° Rnn ° n ^ ^ =4 < NrDn "+ �1'P' onN „ ° ^ 0. 6vw,,, o ..]
1 to x 0. e,ce w] a ...a"• ^ � .w "b 5.°b a.5''0 - ( cro ° 9• ^ rnn•,,,.n,'1 ° 5 M...Pi � [�7° o m '}(r��ii ls!
y IT/z7° c - o S ° ro N n 0 ,ro :.ry • w n S r o a.ag.70 l 0 - : _ Y
ttiw " w' no 5e �•n , O b ^ gMM5- F, `ro .R^.. _ ^ o 0GG S° O a. 0.� 30 M•9• a.
.g: YC�7••�•M.1i 00
'111 g 2-.n N e N•ro v n'N. N C N•a1 5 r9 r° S N '4 ...° -•n ry O * 00-ry ro N w cn r0f -I.• ►ri ill r
s O `` woa -1nc." 0w4 ,-.5 n ',=,D°° -'douw n,^, =" " f 1 Sf<wcn.ow """ A*�n �. •x]e."•
." C r ... v rD ^=D n 0 O A w O °='v n 5•G.N �° �.N'� 5•5, •; .. : '•O a.....=- •, w'5 0 - @ P-j° te.°, "1Z
5'E r.'< N'5 ° N ° rD "t ° -, •C fD ° .t+, N. O :.,0 w n .3 2 w .0,:,-.W ° TM y
0 g ›CIS f1, nwNw ..°'^.n ]-rDr"'• w ` ft n,cory 0 ,, OG '•.c'O5•o ° V •„,< -, " p,MaC" • xo .. r 0A
M
.•.., 0 ,- r..r..it °ro w ° N ,, "J ° a n Q cD ^ ° `4 fp.'< > `Z •�y
r .' r+ io ro - ° H n 0.a. M =' P7 '3.pQ•, a 49,0 N pt a rD `.< 0.04 7-ry•, c �j• •o p •� G A d ~'�
q o• '� ere •c N 7 r rD Q. ^ ry•o n ° rc ° H'^
y ° x P n ^ cm .-. o K �' o.< . O < o ,, fe ♦ �+ < �+ S i rA
a O° , w n rSD n- w S n °ry °p < ^ ^ran ry n c. --N o ~N w ary �a 2To 1
U+3 zq .ry �n ?; o v.n"'ro wry 9- =" 3•ao:. c 'C -.•O N.F. w-N ry -= 70e 9
�. .+ n c,.a y^'"0 o c P rSe ,'< °, K 9griO -, 0 6 N rD o n'Z»•Rro re r+ t!f
o3o ° c ° Q ,e .' 5 gaN nc .^ wo o n.o *f'02 to
n O' C N n a;o F.� 0,9 C n N T. < A:H = c r-1 0,�.0 aN 4r', �S=•r0 ....-1 r.g of
Fk•VI 9. P. w IR ri ri chi a ',1,-5, 9,, the -. g •a'0°G 4e- P•w.0 O.q'w 9 a T°.^i 8 0.^ = �,C,.• ^^,,