Farrington, Baby girl 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.
Dist. No..6-6 0/ Registered No.
County 121/ajiriee/n., Twx44---
1111 fQ-"Je'V-e4len r) laieeal hfir2*4d
(If city, give street address)
or City
Name of *ceased ..,...ailp %...ar jitinctdie&rzd
fi .4 Si le married widowed,
Se)Far;ervIdeColor A,jA.411t;or divorced wi:ite the word).-efair Date of Death.ja.4t.2.17/ 1963,
Age • A 43 ' Days. Birthplace
Cause of reeath
--Cektiglikeitras-signed-by - . eId 1 P M.D
Address
Place of Burial (or Removal) ?nun/ 2thakteen,ex.* Iv
(If body is to tempora ily hel 11 in space later)
Cemetery Date of Burial (44-44.red. Died— 147
(If body is to be temporarily hel . fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful examina-
tion, the me appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have acpOted the same for registration, have recorded it in my Local Record with the above stated Registered Number,
and zt,basiAthereprifl RE Y GRANT A PERMIT
Na
to .,
the ,-uryvine!.
to hold temporr y and ( dress)
the body.
D4tod
(U ertaker personlinitarge of corw (Signed)
) move, or Eh" isencliCer.4..ate h ])
1 9.3 7
:7:al Registrar
--
This ermit is ufficient for the Removal (and Interment.or Cremation) of a ody any par f the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Transit Permit (V o. 62) is required.
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