Celark, Helen Form VS No.61 NEW YORK
STATE DEPARTMENT OF IIF I.TH •
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
-' TiihsP'ermlt can be signed,issidy by the Local Registrar(Deputy or Subreg stear}-ofthe Primary Registra-
tion District (Town,Village,or City) which the death occurred after the FILING and acceptance of a COR-
RECT AND CO�MPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No.
�Y 6 f Regist ed o
County JqQ Date of Death —
ge�vti;'vi1- 191.4
1 City- - _-__ --7_.._�... Sex /' Age_/-PP rs. Color '
(Cross t names not applicable) Or Mos.)
Cause of Death
Place of Buxial ,/ �j/� Ceme-
(or Remov l)_- ' 1 j%( t y _.._..._ _D to o£ B --•4,
�. - � �.,�. '►tea A CERTIFICATE OF DEATH of =�"'
(Give full name eceased)
having been presented to me containing the above stated particulars, d,after careful examination,
the same appearing tQbe COMPLETE, CORRECT, AND SATISFA-_ ORY AS REQUIRED BY
LAW,I have acpepted the same for registration, have recorded it in my,Local Record with
the above stated Re istere Number,and on thee/basis thereof I H EBY GRANT A PERMIT
to fL.i4it - 2z:
(Na of U rt er) (A
the to the body.
(Und ak o erson)aryg charge of corpse) (Int ,r mil or wise dis e of[state how])
Dated -1g1.3 (Signed)
Local Registrar
This ermit is sufficient for the Removal (and Interment or emati )of a body to any part of the r
State (subject to local cemetery or other regulations), provided,th where emoval is by
common carrier,
the above Permit must be included in the Transit Permit.