Hoag, Lydia NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sir-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..5.60.1...................... Registered Noll_9....._....................
Town
County. __.;TArren _._...._._._._._ village 12Elizabeth Stue__,.G1ens...?alls, _ . . .
or City al city. giv. . m address) _. .. .
Nameof deceased._.__Ly.Slir3_.;:9.AC..._._._. ---.--.___._....___._......___._._._ __.._....._....-•-•---.--._....._...__—.___......._...__._
Single, married, widowed,
Seat.Ql!)ale...Cotorrfltite_,or divorced (write the word)..._ _fuar•.Y.S.ad...__._._.._Date of Death.....April.._.1.C.,. 19..3.
Age.__..._.__-_.Year........_..-_3 ....Months.._...._21....._._...I)ays Birthplace.._Crib rip m.,r-„Y'«_..y...._._....___._..__...........
Cause of Death.._..Qar..e..br_al Ea.e.mar-r..ha.ma-4_...dads.... —r.--•_-•----._....___._--_---.._._....._...._._._.__._...._.__.__._._._._...___.
Certificate was signed by.._.__Drs_._'.:.I'f'_nt._It.....Fa1kenbsl_I`;' .---._.... • .__.._. M.D
Address......._...__, Glens 5'allsa.__T:t�..._r.t..._._.____._._.._._.._._._.
Place of Burial (or Removal) TQ ill....Q.L..._.Q.luQ nahlary...._.ilarr.en....G.Q... 11.a.Y.._._ ._......_._....._...._..___._._......_...._...._........._
(If body is to be temporarily held, fill in pace later)
Cemetery_.___._.._?i nr Ii.ea__.Ceme_Cemetery Date of Burial..._....il Apr ) it
(If bad •d ___.._....._......._..._._.—.__ �,. _.1,a.r. __193'I_.
Y is to M temporarily held. ill 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 on the basis thereof I HEREBY GRANT A PERMIT
to_._.._._....._._.aa.1".Q.. ..S;+ js._>z..ti.,.,a,..j:._R.X'sl......._._...............__._._._...._._.. Sx].B.AS...:_..1ls..,._........_is_
---...._........_._._.�__ _
(Nan.) ...
(Address)
the_—.._.Utz i. r.taJS,@1`_._......._.................._._._._._.._...__.._to hold temporarily ' . • tarry/( the body.
(Undertaker orpersonpeon having charge of copra)
i� ove. or otherw, p«e..of the
hoed)
Dated_........_...d_April. 19._3.7.. (Signed)'.... ... � m- ..% _..._........._ .. .
Loral Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pan of the State (subject to local cemetery
or other regulations), unless removal is by common currier, in which case a Transit Permit (VS No. 62) is required.
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