Howard, Melville Form VS.sL ' NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
£Ir 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. Town Registered No.
47 Village % sZ
Dist. No �Ql.Count or City �, !,♦ ••, •fP
y (If ci y,give street ad.dd • s) .
. --
Name of deceased.... ... / . .... .. Veteran
�
Single, married, widowed, (If veteran, give name of War)
10
Sex.,. ......Color % or divorced (write the word).. .. Date of ea .2 / 19..i
G.
Age Yli Years Months D s Birthplace.... �.s,.x
Cause of Death..., '9.4. erJ s�. 2.w. .e2s •
ree,..•
Certificate was signed by • — M.D.
Address....- . .. . ..f.:. 04��^t‘,,,
Place of Burial i or Removal).... .. . .. 1y....,f'/..- Vr
(If body is to be tempora held, fill l ice later) /j
Cemetery ie-, t.{ .44/C/- Date of Burial „p,�,.Pe./ - (a 3 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 appearir:g tu, 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 on the basis thereo I HEREBY GRANT A PERMIT �J .
�,, ) t )
to a,:.. .. ... .
Name Ad ..sLa� t...
the . . W �z� to hold temporarily and the body.
U ertaker r perso having charge of cy�) n ,re ve,or otherwi dispose of[stye how])
Dated:..(�..4‹.-• a..s 19...��.11. (Signed)
Local Regis
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.
r'H'0 .g0w ^.w '0 r.Cncn 00 �O0 �•, n m 0 oxro o rn N .t y n o• 0. ••,,... C)S`r�CA •i.�
nMn 4„ •7cr0Erbme0405:4 r.':+O :1:"" ° 5•.n-..° maomfnYalO.° $ f97.000 Aa� 0 - re v PI
n -, 00 nC r9 O •' nnF .n3 ro � n n'.
-�•q A9na-• wmMOa•O'yw�,��,w.aIr50 -A^OQco) •w', � n3 '=P, 4aroc_'rl2non ,� -< PC< p-ro n "1.
z:: a <<ro a A n < a,;.0..
re o n CAE Cn -9 m
qp�a ' ,C5t.050 -°,"rrep,� `%° :'o'oo ."5-p5•'d,$5'ow tv� � :-, , -. �= °.'roa,, t„. �.g--. c.aw " .., Raa P,. d
e n o y o n A .. V A -, ro c o4 A •o 0 o £•a _N oo .. 0
g. T ,n.A.yw < wo -,;y wOy.y ,•r nn -t n'<a,.• ei O'�.•y,.0O •nOO w " "1O .Or 0.W Vt vO -
r . k to .., m 0 y O A 0'•• r' n •p 5 0..+.< 0 < O n P� y N 5• 1iy p•' Vl
^^^777 'E A to O .t•`J w �D N f9 .N-, w n N G. �p °'�f .7'• t•J .�'�v p
�`•<0.j 4'O,t Oa°,w R.O a N0,•n � ; co•00 m, *wn c,.yi,-Am -� o -a2.;, 0o gnt0 10 es 722(A .
o•O a-1 n 0 co '4 *X V,.V ,+
n5•^A -+ � a.wo � " A' '4 -°� C :." �" �'_w0. '.y. ..w n0., •R n � 0 -3C7a o'pC�'7
O.� n " ,.0.7- 0• .°.,`t G *R '�..o a , y• n „�. .'.r a.°..`7-, a C -� a A 3
A 2 �' a w n E Camay=B w .c w ro n fn eTJ
i nc/) '+ Cw;'" :?ro0.•� orjnnAo wnAwy .wn '1',,-,ro .SC- w O9 R O A m w.O Af y n a', ti n 7 x0 n w ti- n 2 `n O aO = ^'" ijfti
fDww E Cn �'•.. < OWNa acr aw •w o 0 0 90
o c▪ o 0 G -,-I 01 c a w a 0 ° o �D 0r,...• ►Cro ";;a., 0 S `n'�y o w 5: 2, '' 5 a'o w 5'` to '" �9 8 En
C 0Z --IIO ..�.nn .n •iyCG � On0Orn, 0 -o Oy ,q0m p wC ° CyQ C w�O
�w n ro rD o Z -e ., ., a^oy �'^o• y n a w �w E < C e "a'C> * z' iA
2O 00-P`..rtnaa ^0WnO K.m , •-• n � A O Tn y p.Ay ^yK 0 .� C "" .' t'r1 o "d ,°. -rt. w-• nb 0 -t •O. p .. n Yy p. p,...,=,,.Q.w a O S
�;v`4 Ch 0 Oq n' y o `t n co- ro 4 n .N II'?.'1 .•.O ,Z w w ry rD ?��,n � M N ° w�.`� �.v't+f o �{ n
0.- n* ° «r -, COn ' ""J' mn 0, -ty 0 -0w wA O. o .. < 0 0(/�
C �1.0•nn"� r�o �•� 00.7 � �`'.bm 5.00ioy -n0 Crni' »,5'nnTs'».p-riy•GCnn.On � �] w•p .4• 0 .o.' 0 Zr
a. .• .NI. aw 0 � 0- 0 •,bwl = ?_' KKT� .n�.ti y ro O yn'd ° 0. A "i 9.1
6.lalO .`tOp. x°..oyA -t r-,fwin .-w 0 •°,0•n '9• -t -t0..°..0 4.1 0N` c ^cr A S &'O ,�} p n '^ Ir
A n ,S•ry n n N o y ", A •s S A p W ^4-0, '-, w ° a inr C'< n0..0 w M :"i n» 9 •� - i"+��+poi
4 "e1..j `1 w •• nt9 ° ctm sr G.0 n ' FSb .-.•2 �yG a•o'A, n5' n7'` OW0
nX in a5.o ^ ° R � n .,s s 5 , o :?^, ?:° n, �cww -, yw � ^ � �° trd • t..
O V)rrj� w 00 a""t9 n o...0 O'w a'b •" C• .'On Fs. n 0y a:p, m•-•< C n =� a _< o - Z
a, av�,. 5'Q ww ..y a 0 0=• °.w O•o n o w ° 0 =5 5-0- p3 y w R •0.....a p•OiZT,roy ^ rnn
" cAO,. P 0w •w �•.43 w.n 00n to`<A 5"r-+1�.9 -gg, O y A'..w.ran ai .^y p,.a,, n z,^ r., 9 o .o "]0 't c•'i to, Z0
•• •TI m• .J.^0 p < W ?- O a.w !n O A .Ay S•z a n ..''� .-•o.tp o+ R '' y ; R y', 0.N. r^'.� 0 9 _ M}�'y/�r
Po x 5' n n o.•R as m o • »0 0 5 .,' p, rt n n p,' A O'y 0 .n », Cr"ro R 0.w w O ^A r I A [A b " X
D a� S 5. -t a 0 p ,o w '•n• ��'Al -I m <ro -+ n-.0.cro M -t p`M w t2.A •.. • 1
`/ -z'z' ... 5•n 0-O O•w•Cu A w..°•i 0 ° OAOAR < � CnA ,O a-`neap yO` -ni�°AAr� � 'DO « O • \ •
Pi
o N �' no•�a ?; ^ , ten... ro ^; c •?' ' oaro < �•° ,y.•wp'p's, -, 59 0.•nc� � M o . 3M
03 rig. . RM 5•r�o ?.2,?'.4., ,0."O+ � nwrnv, .oS y mpa *V C.o (7, mmm -0-m, C C A 0 0 fn
.. 44 n ,. ro n•O 7, C ,+C n ti' Ai a K
_J'�.''`-'�'-�t9_�25_"..pQ. 'C -'d n n '�Y•0. A ° G n ^t n ^ 0 " rl tv
w ~ .�5_ n-.. ,7,.m-I00 -''..< n ^. :'or:'.09 " rpm P'S_P•m "4 *4ti «.113 n. V O
5▪ G" ° on 0--orgo '2'n' n, H c .( r 3'R2 4-0 4;w `"f 4' :0 ,7,•o-73 aroa . a w `p•6 iT/ri 2
0• -t Sn W,-, n w .. H 0 OQ P.1
C A rpm ?� v, " C o 0.w ,-1 mo ~ h i.n
.0 G� `< ^ °A' n 0 nro ^7' O. p 0% .Ti. n•O rp n tD 7� w O.r..0. R• ��A
�""'"" •g ,, n"C w O °., y p ...Q,y •.. .n 5••Ci ^� `n c (., o.. •a-.e m w••0 ry G'`y A iT.°�+ "i.�.'
p tt r< y p y O r9 ~ ,..''•, f'O n = m O ., M ".. ° 0• w n B n w O ..r04 p `.p•01 .•t'co • CA
i E .'�Q! Oyw'OOn;'7A `rJ"^ yy•�J. 7`ro•
SN M y ° Sro cx*`-•pw y .w O .T'A 0�0 tr
n
,'. R � ....`n ..' nn n `--C.ii' w 'rho n•C OOp, a �- •C " ro,d "^y < »,Y co C a.•., aC" •Si Off+
•- to 0 w ••-•n o•p w O y ••, � y n _ O n Pm p ti row x may►+,
T'.. 7 y' O n .y , O 0' 04 ,w.,a'O'n., w '•••'C •i C r9 .< a.y 5• -, C 5 .aa+p'p > O Q /r
O, 'r !D.p n C y p•aa,w. 0 •
A • ° y r.A P w. w G.rt A Oro 0 -° f9 ° Pi•'" r
y O21' a`n OQ 8 Ow O "O� ap`< 5cb n *-nw n ^' 0. < ,, y •'^�, �w
n A nr.,O p'y` n .n o'p•,0 .. Op .< n ° a..-y ,..p, to cl pp• EwO X
p ; x; 9n .. •wy �� p ..'- w-, " yy8 ^' '+ ��'.w° � w'?-"' ? a 70� n'
a ."C °• ?' n' row .z c C n
•, '�'� Mnna...' n -.. tip 5• `< o ".pH 9O'r.., m8Rv", ROn•Z". 4" ....< Cry c» t.+ m
O 0 Coati 0 ,, o'< n n o ^ , = @ w v ° n ^ n c -Po w o R o g oro 1+7�x 4 4cD
o xj m.r.y.� tl , ^.pa - R..0 y w 6 4•.w, ^ -,,< p y 5 0.0 4 a o•o[D G w •-•.:. m N ,,���"yyy1 g �/► O
Q,mu p•yp A.? " ry•...?:a•a A y A'r14 .C' C'O p•<w�zn n O A o n o w��p1ppp .�.`?• 7�• p1.
�'�-., B.n vi n 04 y 0 th `< •°t n M. =n 0 p 40 << -. o a E.w 4 w 0-° . p ass 0 V�'". Q'�` -``, -I