Barber, Sarah Form VS No.61
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
'dti This Permit can be signed only by the Local Registrar(Deputy
tion District (Town, Village, or City) in which the death occurred after
COR-
RECT AND COMPLETE P y or Subreoistrar)of the Primary
CERTIFICATE OF DEATH, LEGIBLY the FILING INK.
gistra_
Dist.No.;6 5 WRITTEN IN DURABLE acceptance of a LACK IK
County__-_ Registered No._ `�
Town,Vi}= ( l�i Date of Death_�.'� /_--
-"-------------
.191
(Cross out names not applicable)
Z/ Sex.'' Age JCS Yrs.
•
Cause of Death (Or Mos.) Color__-- 1u
�v
Place of Burial `71"ri '�'� Jhi ���vt. �
24L `�j
(or Removal) - ui-*=' Ceme- ��i_+..7`.....
tery Date
of Burial__
A CERTIFICATE OF DEA - -" -"_191_6'
having been presented to me containing the above stated particulars and,(Give ou f geoeased)-------"-----
the same appearingin
to be COMPLETE, after careful examination, E
LAW, I have accepted the same for registration, have recorded it in
AND SATISFACTORY AS REQUIRED BY
the above stated Registered Number,and on the basis thereof I HEREBY GRANT A PERMIT
my Local Record with
"
Name Undrt <c-^-`----, -- C-� �l
a r) "_'/ L__'
the C `
Undetx �j ress) --"
( �r r or person having charge of corpse)
Dated_....__.__ (Inter,re r ther the body.
- - -----"-"-----191-- (Signed) of 4+4° [state how])
This Permit is gufl'icient for the Removal (and Interment or Cremation)of%aFk -____State (subject localucemeterycior other regulations).l(anLocal Registrartoi
the above Permit must be included in r o provided, thatbody to any (
official Transit Permit(Form
where removal is by part of the 4
( m VS No.62). common carrier,
i