Baldwin, Mary rpm ws61, 1.23-23-2S,9p®(17-1154)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Ili' 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.
Dist.No ,?y,, ,ra? Registered No. •'-.
` o wrr
County ... . . _Village.... i »».
of City If city,give street address)
Name of deceasedA. . 4 rs...» 4` Months.... .. Days Birthpla _ »
Cause of Death... ..,2... stY! . » .20.E .,rr of t e: am...tee
Certificate was signed by.....„... »...»................».. ». M.D.
-� � ,� n2 '`e .a-�.t'Address ✓f/.
POe of B lal (or emoval -e/n�/�T.I� C.. . ,, �y
Cemetery Ye»» . 3_. ;,.i 4/ Date of BuriaL........L [. . - Z 7 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 examina-
tion, 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 above stated Registered Number,
and on the baesis_�••theereof I REBY GRANT A PERMIT
to_ (Name) W.c
the--- ... „ � f1. to hold temporarily and_..........»„».._...4� ��„„....„......»„....„„...._»„.„...the body.
erta r person having c Large of corpse) Inter remov th filise di o e of[state how)).
Dated..... ..„. - 19;, (Signed ....... „.„�. ».
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a 6 y to a part of the State (subject to local cemetery
or other regulations), unless removal is by common carrier,in which case a Transit ermit (VS No. 62) is required.
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