Whitton, Anna n VS. 61. 8-16.35.50,000 (17.1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Ear 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. .5-4 0( p / f� Registered
No...:/.,(...7
�i Town r �r * ''?l*-'J�'u'.,. 7
County (��1��f�.Q Village..
�� Q� or City (If city, give street address)
Name of deceased GC "-vY4,a
ingle, married, widowed,
Sex '4 Color or divorced (write the word) "' Date o Deathh .......„...... 71/ 19 36
Age 70 Years Days Birthplace ''_-- -
Cause of Death ... 1a-e
Certificate was signed / ' M.D.
Address .../-fig '
Place of Burial (or Removal).. e2. . r.14/ ..it 21441 �
(If body is to bet rarily held, 11 i ace lat
Cemetery Date of Burial ,/.... 193
(If body is to b mporarily held, fill in space later)
The Certificate of Death containing the a ove 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 b pre�HEREBY GRANT A PERMIT
a) ress)
the to hold temporal.' y the body.
(Und ker or gers hay' charge of c s�r ter ove, or other spose of [state how])
ated !` 19.. .6 (Signed).... ....
Local Registrar
's Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local cemetery
egulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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