Saville, Hattie a..a ua ♦o. ua. 0.10-».71,,VVV 11/-142s)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
E llir 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. Registered No.
Town
County Washington Village F.Q1'..t Edwar'(i.,.h....v..
or City (If city, give street address)
Name of deceased Hattie Saville
Single, married, widowed,
Sex F Color SN or divorced (write the word) Date of Death July 29 19..0
Age 56 Years Months Days Birthplace
Cause of Death Asthma and Exaust,joA
Certificate was signed by Z- . 7 ... ... ---C,.,._._ M.D.
Address
Place of Buiial (or Removal) Fr Om Union Cern, E:t.,..E.dward to West.,C,t..a,..e..o.$ ''a. ,1.r Gatti..
(If body is to be temporarily held, fill in space later)
Cemetery Date of Burial Aug 2$ 19...3fi.
(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 the basis thereof I HEREBY GRANT A PERMIT
to Q..W•collins &Q...Glerl.s Ealis.,.N... .
(Name) (Address)
the under, to hold temporaril and Remove the body.
(Undertaker or`person having charge of corpse) (Int remov or ore a dispose of [state how])
Dated Aug 2$ 19....36 (Signed)......... .. t„ :Ci. .. A.
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (s bject 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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