Bosner, Estella NEW YORK STATE DEPARTMENT OF HEALTH
O OFFICIAL BURIAL (OR REMOVAL) PERMIT ,
ilfiWThis Permit can be signed only by the Local Registrar(Deputy or Subregiatrar)of the Primary Regfstra.
tion District(Town Village,or City)in which the death occurred after the FILING and tance of a COR-
RECT AND COMPLETE CERTIFICATE OF DEATH,LEGIBLY WRITTEN IN DURABLECK INK. 4
Dist No...._-- 6601 Registered No..___.../ ......_..
County Warren Date of Death-.,FfifrtR�-._ 11.:..I9...4 i
Town,V 1- City of, kns Fd i is, Sea .. Age__- �y--z rs. Color--_--_
(IfIf cat city, City-or t a ss , Or Moe.) _ ,r..
Cause of Death._ �_ - .
Place of B ' (or emoval) .- .
L�Sad ia____-- ___.__ _D of Beal
Cemetery _ ,.
Certificate of Death of _._ �. V '
(Give full name of deceased)
having been presented to me containing the above stated particulars and, after careful eeantination
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED B'
LAW, I have accepted the same for registration,have recorded it in my Local Record
the abo eta Re ed ber,and on the ba ' thereof I HERIEIRANT A PERM
(Name un ,, ddr )
la. - l!_to _ _ _the y.
(;Die or •- <.. barge of ) C... i
Dated - i9•_ I (Signed)._
Local Registrar
IT Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the
State (su•ject to local cemetery or other regulations), ante**removal is by common carrier,in which ease a
Transit Permit(VS No.62)is required.
6 d� � A
ttAtti
11 a % a
s ,.wiwnsi. tii ,D 7.21 • .1 \ lit tn
e 0..5' P'"Wigt t tilr..n% t.:1-1 • t t4 fl
°80Vwstoem n i�as � sis pSi:� %p aQd' 'i °1 F+.b' R. �7 p e t .•
toop
....ilmstilAv vs- 4...-e.12.4t, ,AA-0:-
� GO a�°a�� �,`�..`�agrs.°� �".g'°'`���p b'13*
g. '� A. $ o 'a. • H to
�+! 3 'gib�' fiii aa�� Q��i�
• I. -V; ''°'.dry ". �p9 o"�� 0 aao �4 i'... a O.' a VI,. W�: . .,,' � r�
o �qQ gg tl a o q^'� sV% .a Va ddP• ' i a %\ %%3%; �„` ° f{
itriii
py° $� e�' �~� Tr vi.A a 5.949.*0 Ocoee �7 R la i. l �
AIM- B ,o Pry o'Ab. oa•Qo S aaaI' /o,5 y° t►►."'III.5. ° '
.0014 -% as C 4V � c ti�n� $`'5.o � V.P") ►: om�, v1"� O
.ii
� ,a K ' ,$alb. ivvø
L < �$�Gntt
Q�yI.
ri�.1 ���Ty ce�g � Q.�p�. p ��y en- Gam' S3 O 1 V.� 4ti - $; i4 °tt:
g O$ i ggv li g g e• lay a o m 7n ra G ~
�.. ....1 ilia 5. nQ2n
Q