Beaudin, George Form VS 61. 5-24-35.25,000 (17-8593)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ilir 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 6 0 f Registered o.
County__...-= ....__.. ........................w.......-....... izi la e _ . -
C� z A.T City � (If city.Hive0tr_eet'address)
Name o deceased.- . --- • - - --
-
,. Si le,married,widowed, '
S Color... . •or divorced (write the word)....... . at fj D eath �, •l • 19...,
:Age _:0 I Year (� onths.........2- ays Birthplac � ✓ .s. l� �f ... -
ir
Certificate was si
Addres _............ _ ....w.- _.-
Place of Bu ' 1 (or R val) ..-...-......._...._ . ...
(If body is to be t(j arily hel , i e 1 r)
Cemetery ..t 4 . ........... - .._.....Date of Burial--grAlooe.441.7-19-as/7(If body isto, temporarily held,fill in a 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 epted the same for registration, have recorded it in my Local Record with the above stated Registered Number,
and e basis thereof I F E Y A PERMIT /
/ µ C G}C J�, ,�
O/
ddress)
the to hold tern ra ' and-__.-.- _ -..* _ / —the body.
dyer or pers ryaa • g charge o err ove,,i.rwis e f tate how 2,
Dated � -17 J.l0 •� 19.E (Signed
Local Registrar
This Permit is sufficient for the Removal (and Interment or Crem ) o a y to any part of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which c a Transit ermit (VS No. 62) is required.
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