O'Connor, Frederick y ��STATE
OF NEW YORK.
Foam 6.P � RM ��-
BURI `� L
n / 1 `//�
Name of T0Couut9• ...'. g,. ........... is hereby
(yi11a8e) ana (Dated),•V'' State, permission ofthis
.... the Laws
' as required by .rigs,•�''
been furnished tome, /!'`�` ••••
Death having f. � .. i��.
r The Certificate of G[ .... .... _�G�
., . the Count..f
1T the ...... of... mac..... ................ .... ..,.
2. given for City or Township.) ...
. ./, e of death being
who died at • "' �i the cans
&
Place of Burial,
• .. ....... T .• �/•
/j�7'/'/�1�`� ; (Signed bg1• ` �, L.�e;-:a.�`.a!''?;�!`'`�• (Official Title.)
ersol: .V.�••'.._. '... ... A.
o• Undertaktr oT�aaraat, iJ
s in charge of � '? �:( !�^�'-'•.. ••
•
9� Residence,
r
r'
BURIfIL PERMIT
haw of Deceased,
f{kO('I.ej e -
Date of Death,
r9 frpp
ause of rAi .
eath,
trrite-vetow (Village) Citrp-o.f 9( t l.A,q--4-e'.
r
County of..
? • --1-7444-1-4-44-------
Xl.A.....4....' (1---1-4-4A1 6-4-4—(-1-Z-4+-1.'
•
NOTE.—This permit is only to be issued for a
burial within the county where the death takes
place, and is to be kept by the cemetery keeper
where the body is buried, It is to be issued on the
filing of a death certificate,certified to as required
by Sec.23 of Chapter 661,Laws of 1893.
NOTE.—Burial Permits,and all Blanks,are to be
procured of Town and Village Clerks and Boards of
Health,for the registry of Births,Marriages,Deaths
and Burials.