Hopkins, Hattie Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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 aCOR+
RECT AND C MPLE C RTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK IN .
Dist.No.._ .. Regii ered No
` County f sate of Deat "' oc�.G:r .I 1r-
Town, - ! _f
Se . ,,:�/.ge.'�. Yrs. Color.: �.i�9
tor City" (Or .)
(Cross out names 'ea )
Cause of Dea .....
Place of Buri Come- a of B i 1. . .... ...a2.L9ir
(or Remova
A CERTIFICATE OF DEATH of •
(Give full name of eceased)
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 a ve sta d Registered Number,and o he basis they f I HEREBY G T PERMIT
_..G_• ..�.. + �1 f_....__ . _..... 11
to. .,
(Name of ake ( s
th t r ra the body.
( dertaker or p so vin charge of cor a (Int ove,or g ) impose of[state how))
a /.1T.. •-.o
Date ._.��.. IgI (Signed).. . _ ...._:_ .. .Z...................
Local Registrar
This Permit is sufficient for the Removal (and Interment or remati )of a body to any part of the
State (subject to local cemetery or other regulations), provided,that wher removal is by common carrier,
the above Permit must be included in the Transit Permit.
342-17-25,000(21-4256) ,
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