Munson, Orlando Form VS. 01.. 6-10-59-9U,UUU (1/.1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ffor 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. 07
Re 'stered No. 7
� ��3 3
Town e 1��:4 'st' lG .z 9€ �r 1.
County Village
��fJ or City (If city, give street address)
Name of deceased 0 +
eiLd / /,/ 4—Single, married, widowed, /'/ 13�t 193e°
Sex... l2ColoY� . ...... or divorced (write the word),,, " Date of D�,ath
Age 7 Years f Mont / Days Birthplace �—
Cause of Death asc.( ¢_ .
Certificate was signed by • �.,1k.`Z M.D.
Address �/ - .j/ .
Place of Burial (or Removal) i '2- ze e•e, /L ' r
(If body is to be to orarily held, VI in space la
Cemetery --r.-3.,42 . rl-e-u Date-of Burial ,r • / Zo 19 3
(If body is to be temporarily held, fill 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 t e basi of I HE BY GRANT A PERMIT
t� "
to (Address)
the to hold temporaril the body.
( rtaker or p son having charge of co ) r, e, or otherwi e of [state how])
Dated /.49/ 19 3+ (Signed
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body 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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