Cruickshank, Marion NEW YORK STATE DEPARTMEL, i yr rIzAL 1 H
OFFICIAL BURIAL (OR REMOVAL) PERMIT
REF`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 CERTI•FICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No. (-37 t 2 — Registered No.
' r
Town
County..�Zfj.... lfy/ Vi1tagz /7j
�j
► (If city, give st ee address)
Name f deceased ` . J C
Ingle, married, widowed, _
Se�olor.-� ivorced (write the word) 27: Date e h... �-er `S>„ 19 3� .
Age 7\5—
Years Months. � Days Birthplace ,.....
Cause of Death s
Certificate was signed by -I M.D,
Address ` 71 ? ,
Place of Buri or Removal) 44 D�¢i '
(If body is to b t pbrarily he ll in space later)
Cemetery.... _,C12.- - Date of Burial 'e-e-. 2- 193t .
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated pa ticulars, 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���t�x�he, basis the f I BY GRANT A PERMIT �Lt�`�
to l/�4 -f� X -
(Name) • (Address)
the to
to •
hold tempo r. and the body.
(Und tk r or erson m har a of co ey (Inter, rem");f„' • -pose of [state how])
Dated Tj// p s 9., g 19 C� (Signed) /�� ,' .�
i•cal Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a y 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.
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