Finney, Asa Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra-
tion District (Town, Village, or City) in which the death occurred after the FILING and acceptance of a COR-
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No 31-- 5 7 Registered No.ir'' 44
County +1!_ 4-<-- Date of Death ' t)-eG• 9', 191
Town,Vil-
lege Sexyn (i Age -Q4 Yrs. Color
(Cross out names not a licable) (Or Mos.)
Cause of Death.__ -Lt. /_.4- U a- ate
Place of Burial Ceme 4�f�,ly4._ ` Date of Burial__lag.a // I i__
(or Removal) tery 9
A CERTIFICATE OF DEATH of •2•••••&2 47�(Give fullm e of deceased)
having been presented to me containing the above stated particulars,and, after careful examination,
the same appearing to he 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 basis thereof I HEREBY GRANT A PERMIT
to /*Cei),3,2,1k %� V/r132... ei' - 4'px--
(Name of nd rtaker) n �_ (Address)
the 1�/lar to .V.- ,(/y the body.
(Undertaker or person having charge of corpse) (Inter,remove or o}y wi pose of[state how])
�> /JJ
Dated �,?..4 C____l_!1 191-(.� (Signed) - li l Reg
j1r Local Registrar
This Permit is sufficient for the Removal (and Interment or tremati n)of a body to any part of the
State (subject to local cemetery or other regulations). provided, that where removal is by common carrier,
the above Permit must be included in the official Transit Permit(Form VS No.62).
a