Murray, George Form vs 61. 6-8-34.50,000 (17-7901) -,
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL B€JRIAL (OR `REMOVAL) PERMIT
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
WRJ'TEN IN DURABLE BLACK INK.
Y�.Dist. No...0' ... Registered No.
Town
Countylage
oo�r
city (If city,give street address)
Name of deceased -. ,Ot�� .
Single, y red,widowed,
Sex .............ColorZ` or divo ed (write the word)'.,. ... r , Date of Deat .. '... ,. . .t19c3 6"
g 7 3 Years Months 3 Da s Birthplace .F��
Age p °
Cause of Death
e1-?;
Certificate was signed-by ,j�.... ( ct,./Z .. , M.D.
Address ,,�._.r`'�- ..
Place of Burial (or Removal) -. e- Q�
(If body is to be temporarily held,fill in space later)
Cemetery ,,.,,., ,... -- Date of Burial # ,. ' .5/ 19.3.6
(If body is to be temporarily 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 r istration, have recorded it in my Local Record with the above stated Registered Number,
and the basis jof B G T A RMIT J, - AL4--
I0 �/ 'IY .;. ��
(N e (A
th a to hold temporarily an .. t body.
dertaker or pers hmg charge or e) Jai ao w se is ose o [state how])
Dated, ... - �.-. .5..,% 19.. ...- (Signed) / _
Local Registrar. -
This Permit is sufficient for the Removal (and Interment or Cremation`?f ody to n part of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Trans' Permit No. 62) is required.
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