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Bullard, Fred NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT illir 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.....5-40 0 i Town 4€61-..a /'4:44— egi No. .2--,9 Z-- �n/ County Village ' ���/ s�� or City (If icy, give street address) Name of deceased _/ �� 1 /� Single, married, widowed, ) � Date each ©�'�"' Jo/ 193 Sex Color '�L�C� or divorced (write the word n . Age...4 Years ,? Months it- ' Days Birthplace.. 'A f.... ?�. Cause of Death "A . t Certificate was signed by ; :: t. ::��f`J M.D Address '�� `4 ��-""�`' f - / Place of Burial (or Removal) � .� ." ..a (If body is to be�i poranly la, fill in ace 1 q Cemetery -Le Date of Burial t 9- '• 1737 1937 (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 registration, have recorded it in my Local Record with the above stated Registered Number, and onnt /the basis thereof HE EBY GRANT A PERMIT /jam to me) (Address) the to hold tempora i the body. (Under ker or person having charge of spry) ( , remove, or othe a:1ow of [state how])Dated ....41 19 (Signed) cal egistrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. :t� -, a 0 �1-1 O 0•w O -.,C', ,n O p 5'a,rn 'O-8 5•n 'C7.ry rn b 'L7 $ ~ ° .*Y p y.. ,y,E. O b U1 _ K ,<.,- .y n C. All ..1 ,G ', O G. 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