Kirkpatrick, Baby girl NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Pr 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, LEGIBLYX.• RIT)'EN IN DURABLE BLACK INK.
.. R • No.
T ��
County__._...__.... . _._,.........._._... .__._.._.___ ._._._ _......._.....__._.....�"illage e .-, •= _ . - -- ._ rl.!_._/-.
sty gi snort ad /
tame of eceased._.— ._.... .—.__. .. _% ��jyre_ _/•_•_• •—.__ - —. _` _..._._._._.- ..._.__._._...
Jingle, arried, widowed, I /
Sex. _ .!__.Color__ ._._...! ..or Hire •ed (write the word).._-._...._........_.:...__..__ ._.Date of DeattieZ6�lies ly 7
Age__.__.-D____Years ..MotRs. ._.._._._._ vs Birthplace._._._._._...._._.._.__ ___....-._..__._.__....._...........
Causeof Death—.---...._....__.._.. ---.-•-•--._._._._...---.__._.___.___...._...._._-_-,.
Certificate was signed by_. ... .. .l1N31r._. _._ _......._...._._._.......--•--•.-•--•---•-.---•----.---___.__M.D
Address...._____ ._. _.
Place of Burial (or Removal)
to body is to In temporarily held. 611 in pace later) ���jjj
C&metery____....__._.—____...._................._._._... ._.— _...._.__._..Date of Burial. _.—_ ___1 _-19 7(lf body is to be temporarily held. 611 in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after ca ful 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 ted Registered Number,
and o e basis they f HE/RE� GRANT A PERMIT ��
to..__.. .......__.._...._._._.. __...__LC....._....._. __—....__._... �V .�.—_ _- ___. .__.__ _. /2/7
(Nami(HERO
(
the._ ........_ _.__._..__..to hold tempos ily d...... ..._........._.___.._ the body.
( e key or pets* swine of,cog r, remove. or oth ore of la
Dated ... . 19.9 L, (Signed) ._ _._ - -• -. _ /. --..._ ..__...._...._-�. --
Loral Registrar
This Permit is sufficient*the Removal (and Interment or Cremation) of a body to an rt of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Transit Perini S No. 62) is required.
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