Kirkpatrick, Baby girl OuFn rQ alv.va• u-au oa- .v v ar-oavv
NEW YORK 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 Registra-
tion District(Town,Village,or City)in which the death occurred after the FILING and acceptance of a COR.
RECT AND CQMPLE CTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No /`��
Reestterred�No
County,. --- _ ----___-_• _ _..__ Date of Death ='�c-q<-OS,_- I4S
Town,Vil- _ 0/ e--ig:7 Sex Age Yrs. Color
lage,or C' y
(If city,give street address) (Or Most
Cause of Death_
•
Place of Burial r Removal
Cemetery..._-_- f _--- .2-Glil/"'
$ery---`'� - -; ---� ate f B 1��a,3i1...Iq-�CS`
Certificate of Death of-
ive ul1 name of d d)
having been presented to me cont the above stated particulars, , after careful examination
the same appearing to be COMPLETE, CORRECT, AND SATISF TORY AS REQUIRED BY
LAW, I have accepted the same registration,have recorded it in my Local Record with
the a e stated Re iste Nigh and on the basis t r I HER GRANT A P p ame of undertaker) -1A ss)
th to ��._ the b.. .
r ake or p son-flnchargee of_ rpse (Signed)
r erw• dispo-•'. state ho•
Dated_ i� •
I / i
L e tray
This Permit is sufficient for the Removal (and Interment r ati ) of a body to any part of th
State (subject to local cemetery or other regulations), unless rem.va a by common carrier,in which a
Transit Permit(VS No.62)is required.
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