Strauss, Abraham NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
per`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. 5- ? 6 3\ Registered No
Town,
County.... . . .. . k. 2 r ge.�7 rx02...QA
or�lt (If city, give street address)
Name of deceased . . ... ... ....
,,` Single, married, widowed,
Sex..W..L.... Color.......\.... or divorced (write the word).. . .. Date of each. .l1`r...i...�f............19.30
Age...... ..`Z Years Months Days Birthpl ce....... ... . .. .. . ....
Cause of Death 119 /. t.
Certificate was signed by t .. - I.' .. .... ... N./.5 , ' M. D.
Address . . '
Place of Burial (or Removal) ` 4.0- -/, e
(If body is to be temporaril held, fill in4pace ater)
Cemetery ... . Date of Burial..$)A..LIY' ./c4 19..a f� _
(If body is to be tempora ly 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 accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and onIthe basis thereof I HEREBY GRANT A PERMIT 0 r'7 XX/�
to .k,..�}�4/1../ .� alktAA , h.!�sLAA4 7a. /.Y ,
(Name) (Address)
the NA/4..._0—“ to hold temporaril and the body.
Datedor person having charge pp corpse) (Inter, r ove, or�vtherre-'dispose of [state how]).
/6 19c3.�? (Signed) O�A�t C .. I... ... ..
Local Registrar L*
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ( ject to local ceme-
tery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No.62) is required. /
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