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Walkup, Frederick - — - NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT This Permit can be signed only by the Local Registrar(Deer ty or S istrar)of the Primary Regiatra. ' tier District own Village,or City)in which the death occurred nafter the FILING and ae.of a CDR.. RECT AND RTIFITE OF DEATH,_LEGIBLY WRITTEN IN DURABLE BLACK INS. Dist No Registered N.o County. _W__.----•_--_ Date of Death- -j _` e& Town,Vii. � � _ � "�,- -- — — ._ — -- Sex.f: `_ Aged_ Y s. Color (age,or City (or os. (If city,give street address) Cause of Death. Place of Burial(or R val)_-_ r .<. _-_ -_ .-.._-_-- _ - Cemetery - _ _ C -_/ ...Date of Burial- __ _I9G7 Z, Certificate of Death of (Give full aama of ) having been presented to me containing the above stated particulars and careful examination, the same appearing to be COMPLETE, CORRECT,AND SATISI3ACTORY AS REQUIRED BY LAW, I have accepted the same for registration,have recorded it in my Local Rftord with. the a e stated Regis N ,and on the basis th HEREBY ERMIT/ the ---._.___ to..___.._. �"?.- M --. ,the body. SU�,I+,d, �L ns charge ) (Iater, ,or o howl Dated ' ig (Signed).. _ . Local Thi Permit is sufficient for the Removal (and Interment or Cremation) of a body to any of the State (subject to local cemetery or other regulations), unless removal is by common carrier.he which caw a Transit Permit(VS No.SY)is required. of 0 ssi:to mat' 6—Itt C, G �t? .. .�- r- a'sI oo`�a+ Zit;L cot, mode t a EX f a oh ttt a � sbe'e'u ` :.fi.,�tis+'X 4 i gbu tst ;1 be Y" t o 4°" '" t to t." as is e' ,w bad��w Oa�t �,. t� d , - , low 0 ���.,o.s,�s `,�, tb,.m state't kri Oe ,Os afi.- 4 i sty �t bto t otatoOetyt bt "", ,r* Zd, t$ to be boa�tit;Uca tv� o�f.t 'tbQ r• • ta�°0 0 tt g of t o L a epatt a. sex. oi° -At 0 t' ofi °! of ow ae t taro taws tha 1 s volit t t ettos tQq 4 ste'tif ' au9 'T 0,3 t . z st tbeoa "d tgilo floe cue of t t1i° t. �a1Z �'6txaY` M���__���ey t� ¢°neces q4o s„0 shy e 41 * u► ot ate° ata 900„ a 100.le;'ai l ' �snatta. dolts s ka 17,... cc�a oe'tlt bo . pep-;vies tue tom'~Se• +' ab' ¢ VA °1e+d°'�'�cc ctroov,tug ,4•plate . vit ac .. so tts of_ °� 61ta1s:t tIVt' a ' , a psc�'�s mtet�is4°^�ace of e�uo' ,,s siob 9 ,si, tto° r. a COW." cbace. t°a of tcopate _ .rpa 0t tb tsoa:4 s tOtt he b tt tbtue ' ,,v soosli, be aAsP :00 T©T oWw_"—Art "-- 1,1$ZO °.K ba � ttat°'uo