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Beswick, Endora Form VS 61. '6-8-34-50,00.0(17-7901) NEW PORK 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. Dist.No. ‘..?` b '' ` Registered No.: r...,. �� / Town County .m . . .. . .. Village..: .. ._ ..:.._._ _ or City (If city,give street address) Name'of deceased. .. _. ...________... _._.-...... .... Single,married,widowed, Ser Color or divorced (write the wore .Date o ea .�... f` _ 19T` Age ��. ........Years..'_... ....... Monti s.:......... .....Days —.Date Certificate was signed by. ,jj - - - -- : �. Address........_-..� �? F•-... . Place of Burial (or Removal)..._..._...._.......... ..... (If bed,m to be temporarily held,fill in space"later) �_� Cemetery _...:..... -... ...:........... .......... ...'?` 1.'. w� ...Date of Burial .. ....e.�» "` ..19.3.6: (If body is to be temporarily held,fill in space later) a 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 SATISFAC'IORY 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 ���sts th I Y GRANT A PBRMIT � = me) ddress) OW . : ...... .......to hold temporarily and.. :.. ..r... .............. ..the body. (under sr or rson having charge of core . ( or oth t sa of[state how)). Dated.:.. ...` ../19; . < (Signed)--.- ...... Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any 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. 1 oa f.i o �. a v^ „•"� w r,-d I. i. a.a++ , °w a 4 a E. m ors U .w a" w w,5 1, a. vi W n i ' , `° � � acip, aQ` ° o-a s � b o ak O.c .c 4 � o� o� �d oO ts Lti °� W,'�', ic ageb0 9,a y py �x.w A ›,o 3x, g d, oo 2 Se4.w', lgA C6 B2m O ►4 a,_„ wvw o � �co4v �,4' 0 .gam .a'E c,Eiv"' RiII es a a c-s. "'.a ",0';.: ::~ a, ..o a a a u -•a S, JR1iiiiiiit /. 00,00.�7.. du-' O w:.'' 08 c:. 0a. ..CD ' m F. EQ04;,`. ,na Omc4OL,w O: t.y., i"'Up ° Nw v. 0'i. .. a m .+ cd U v O•.. i. v U u-.°+ . u'gfQ+ � ° ° o"" ovi. i°'.-[ � � >va .d �r°oa�,vm ;� v � il +.. cd6i � ���..: ///yyy��� ( ,_ •� .c p i.._;,..p.s....�0•'. 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