Higgs, William Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit tan 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 COM LETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No._ _0_.t Registered No
County �_ Date of Death___ f / 191_
Town,Vii- L-.4-aiC A Age 7 ` . Color tT���.�ri• _
lags,or City Yrs.
)
(Cross out names not appli' (�Y Mos. / -
Cause of Death i _ - _-'
Mace of Burial e • Ceme - ��[
(or Removal)
'_ -.Date o B ria / _ _ —_i9ila
A CERTIFICATE OF DEATH of _ _ _cif ' /�
(COvefull name of dec-. )
having been presented to me containing the above stated particulars,and,a'•-r i�eful 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 abov ated Registe d Nu ber, d on the b s t reof I HEREBY G A PERMIT
to aei,
(Name of U erta ) (Address)
the_.-- - - to r�I- _ the .II.y,
(Undert or person havin c rge of corpse (Inter,ra„.f_0 /e spose of[state ,.w])
Dated / i91 J (Signed) _ t '
Local Registrar +.
T ermit is sufficient for the Removal (and Interment or Cre ation)of a body to any part of the
State (subject to local cemetery or other regulations), provided, that where removal is by common carrier,
the above Permit must be included in the official Transit Permit(Form VS No.62).
12M171125,000(21.2666
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