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Spicer, Walter rorm vs. 61. 8-16.35.50,000 (17.1423) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT Mr 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. ��(4.. Dist. No. .Of Registered No.../7 Town a�_ _ f County � C" �y:-- Village. / %i�r•-i trGGL- � �L^'�/ or City (If city, give street address) Name of deceased F Y� - flia-e--"---1-- Single, married, widowed, Sex 0424. Color ..or divorced (wri e he word)... -f Date of Death ... J I 19(' (' Age .9 Year © ••_. � ��¢ -�� - 'A- Months Days Birthplace "i 17 Cause of Death .s Certificate was signed by1............. .... �,.- M.D. Address . -' . Place of Burial (or Removal) 'zi.... .r , (If body is to be .pprarily fill in sp ter) / r - / � • Cemetery !tz� Date of Burial 2-6 1 19.. .. (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 e basis they f I ER GRANT A PERMIT to 1 :' f z I/ /;���/ sx r` ` , i` ddress)� ' the -...it :^ to •• hold temporaril .... .. the body. (Un _. er or person v charge of corg�e) remove, rise dispose of [state how]) Dated 2, 19..3(0. (Signed) ...4 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. .�ios. v"C ^w y C.,":.', ,4 w 03 . 00u00 bA+� v w Z ., 0 $,c4 rn m v v m o '-'-,.ay o' aO u t5 O b'C.� O W d 41 G7yc F .„ � . > c • G� s 0 q :V N o. 4d Y. . . . >0 ; a y y 3• �' vam '" q p4u ",� '' v +' 0 ,, w v 4 y ,. • a , dT a � O ° yC� v O cd 0x" y eaq 7:' ,- o q � Gu wa d qvcy.� iv u v >„q P, ~i.y s, u v a� a•'" a) v A ► a WW °(0) a v , v+- O `' v v cd. u v p v ay � � aoaY cG Y. O v .O r.v 7 cti -b ,.. 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