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Eddy, Katherine Form VS 61. 6-8-34-50,000(17.7901) NEW YORK .STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (old rt REMOVAL) PERMIT ow-This Permit can be signed only by the Local Registrar (Deputy or Subregistrar) of the Primary Registration District (Town, Villager 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. Registered Na.._ Town County.. "...._. ilge .. .�i� .��� i12G�d ,cit � / City oY'(Ifg�,give eet address} Name of deceased-- ". !". ..".s" _... "..... " . f Single,married,widowed, ......or:.diyercetl (write the ward) .,Date of D th.." Age Years. Months..._ _. . Days Birthpla e" Certificate was signed by : —`.... ..... �..�. _.. — ..._, M.D. _...... .. .. y"., Place of Burial (or Remova (If body is to be temposfarily held,tinpace later) Cemetery. . --e , 1 v "... _.. ."..Date of Burial s ..2 I9 -s' (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 accept44 the same for registration, have recorded it in my Local Record with the above stated RegisteredNumber, and on the bad thereof I HEREBY GRANT A PERMIT )(Addres bodAg Name hold temporarily and ey. (U or tie having charge of corpse) (Inter,remove,or others/J. dispose of latate howl Dated.."...�..,,� _ .......�.".....19:"..�r.3� (Signed).....".. .... .._....:......". trar t This Permit is'su1ficient for the Removal (and Interment or Cremation) of a body to of the State (subject to local cemetery or other regulations),unless removal is by common carrier,in which case a Transit Permit ( No. 62) is required. 1 y�.,e 4- 'C3 �� ai-.. 5 t..v^3 F.4.',-5w m 33$'�j�i'4Bw o-m_: i. tI t d�V m.ia M v -m w„p i. rm • �at/7Z L. v o °I N.... o 01 o o...p q.... a v.r: O sd. w O ea„... 0'v 0 v �.. .s~ Cd`� (•'� +6 > o'> .'�' >*t1�i°...., �4�..�++#;,'� q L•'�'!� ,� � �r"*p r_v*3 Q O.-+ S,y m ,y,:° � OG� . oi z p..m.. }i, 1. w•..'-.= v-ed v m l bQ. O;ty' 4-,1 ,,-d..7„r v g�,; i+• ai l+v c', O o .q Rt. 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