Hobble, Louise Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Or'This Permit can besigned 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 a COR-
RECT AND COMPLETE CERTIFICATE OF DEATH,LEGIBLY WRITTEN IN DURABLE BLACK INK.
Mt,:No. Regis d_No..
County. _fte AA--.c_t/ Date of Death-..i `'. ...! ..g 191L
Town, Sex .�f1 -._
Vs& ._.. s/ �Age..'v.. Yrs. Color._ . ._
(Cross out names not Pp' ble) (Or os•)
Cause of Deat . .. _....._ _ _.._..,. .
Place of Burial Ceme- Date Burial -t..-27.-191--‘"
(or Removal) '' tery ,
A CERTIFICATE DEATH of .47- -F-a.-- ............----
(Give full name of deceased)
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
LLWI have accepted the same for registration, have recorded it in my Local Record with
the above stated Registered Number,and on the basin thereof I HEREBl-GRANT-A-PERMITIT
Name of Undertaker) (Address)
the ��s���=� � to.--_.. the body.
(Und er r arson having charge of corpse) (Inte remov ,or,e-ctirjwist.diipose of(state howj)
Dated...x! '- ..... -._191to. (Signed)... =.11..0-�` "r' .,..,
t ay Local Registrar
This Permit is sufficient for the Removal (and Interment or C ation)o body to any part of the
State (subject to local cemetery or other regulations), provided,that w ere removal is by common carrier,
the above Permit must be included in the Transit Permit.
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