Blowers, Robert NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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, Village Re stered No.
Dist. No.';:55'°' County t J (T:n or City 1 �n 5 _-1(15
(If city, give street address)
Name of deceased'D Lt LO C Ck.:L i`3 Veteran \ii `-. l.l_).:...'•,k--', --O-
W veteran, give name of War)
Single, married, widowed,
Sex nr>.�. or divorced (write the.word) U- 0 C-lL''�- Date of Death �r)�- (7 19 7�
Age 7c Years Months Days Birthplace 1) �•
Cause of Death C e rt bi..a.1 1i d C 1.U..1 f CC i cj f j i
Address 1 :1 Ih l'1 - K d Ll..:�.Fs-YJ.c).0 M.D.
Certificate was signed by ...�1.�..`
_:LL. aria i --
Place of Burial (or Removal)) l l6_En S bl i t'
(If body is to be temporarily,Iield,ill in ace tat r)
Cemetery Y!v1t. �„ (�.L_ f1'), }t ['LI Date of Burial ;.) lA It) 19 19 1
(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 examination,the
same Appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to A-01-1e w �LA.o ra , 5e_r i c ;
(Name) ..(Address)
the f " t"C1..i C;i i (6(��0 V' to hold temporarily and .........I ( : r the body
(Under aker or,persotgaving charge of co�rgse) ( remo of se pose of (state how))
Dated ��a.......I.:'S 19 Tj (Signed)
caf egistrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to y 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.
FORM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
.4-1-1,
Date of was - "919 �S
(Interment or
L+ F V� eC-L
(Name of Cemetery, Grern _7m- ee)—,
Section 7 Lot No. 0: Grave No.
(Signed) X-41.‘
(Person in Charge)
;-/ r€el
Address �^-
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above da o
person is in charge, the FUNERAL DIRECTOR or U -
TAKER MUST SIGN ABOVE STATEMENT, write across
face of the Permit the words "No person in charge,"
FILE PERMIT WITHIN THREE (3) DAYS with the Re r
of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDERT S
violating the law relative to the return of permits are lia o
a penalty of NOT LESS THAN FIVE DOLLARS NOR
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations thereof.
PLOVERS, Robert W.
LOF
Age: 70
Cause: Cerebral Vascular Acc.
Lot Owner: Edwin Windup
Lot # 693, Sec. 27, With tar Wah Plot
Grave # 1
Case: Concrete
Died: 6/l7/75
Interred 6/19/75
Potter
Undertaker:
WINCH!? Lot No. 693
Address Miller Hill, N.Y. L.F/ Section No.27
Owner Edwin R. Winchip and Ruth C. Winchip Plot Wah-Ta-Wah
Date 8/8/57
200 Superficial ft. @ 41.30 per sq. ft. = $260.00
Location Bounded on n/e by Wier lot; on s/e by Dr. Haviland lot; on s/w by Patto
lot; on n/w by grass path
Corner Posts
Remarks
Deed No. (and changes) 693
Payment Record Paid in full 8/8/57 4260.00
Form No. 01
Record of Interments
. Robert W. Blowers (6/19/75) 5 Kenneth Daniel Thew DOD 1 1 /9/2020
�/
Edwin R. Winchip (3/17/81) 7
Ruth E. Winchip 9/9/03 8
e,
tlx4 h
w (//
0
L 2 3 4 5 6
t.
1 g c x X N k
6 , fI
iXn
/-* -Tocv