Hammond, Harry Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Pir'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. • v / Registered No. / /
County W� Date of Death, /4 4C____4 191 .
Town, �Gz,/,(4/ Sex_ia4Age 9?` Yrs. Color_L%
City--
(Cross out names not applicable//-N\ TN, (Or
Cause of-'Death.... _ 1.
Place of Burial Ceme- _«emu ' Date of Burial / /4191
(or Removal) `��tL.444--- ------------ •--• ter / ,, �/
A CERTIFICATE OF DEATH of______ . -i
(Give full name of deceased)
having been presented to me containing the above stated particulars,and,after careful examination,
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 tt ted Registers u er,a d on the ' thereof I EREB RANT A PERMIT
(Name of Un rtak-G ' (A ess)
the ._ -G--Z �_ to the body.
(Undertak r pe on haviyg rge of corpse) (Inter,re o wise dispos of[state h ])
Dated /` {- 191s37 (Signed , --+
Local Registrar
This Permit is sufficient for the Removal (and Interment:or Cr oration)of a body to any part of the
State (subject to local cemetery or other regulations), provided,that w re removal is by common carrier,*
the above Permit must be included in the Transit Permit.
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