Hubert, Clara NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr This Permit can be signed only by the Local Registrar (Deputy or Subreginrar) 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 1Albany
l 9�/ '' Reams o, i
�R fban y Town
County.. _� _.._. _rjr__...._._ _.__.Fill. _..._.._ ._._.__._.____.._.._._ _..
7 / .•1 -1 (if ary. wren _ _.1_.._ .___
'fat dace �-�4 .
ma led, idowe� �
. ____ t cad (write a ._.___.__...._.___....Date— t._._ _. 19_
41
'ears ._ ..__ ... , Birth c
Cause of Death..____ T' r_ e
Certificate was signed b ......... _.. !. ....•• . --- .__-
Address. __ it
+-- ._. ....._ _... .... —._._.—...
�- p
Place isf Burial emoval '._.._._ :_. _. — —_______._ w .—_._.__ ....
(If body iaroM 6 " �e
Cemetery , _ _ ,..:__.._ /�l•'r...��'� �/,),•"'�e..._._—_w—D ' .._.. ._._._._. __.__
(If body is be to arily add. •'r . War) _._._.. _
The Certificate of Death co lining the above stated particulars, having been presents ie, aft careful exatpiFta-
tien, the same appearing to be •MPLETE, CORRECT, AND SATISFACT( AS REQUIRED BY LAW.
I have acce e for ./•tion, have recorded it in my Local • --. with t e above s-ted Registered Number,
and on � ..so4 ; fI1ffPt .
.._ .._._._ _ _____to hold tempo�� �,•�� <... _ d}'.
(u or .gy�pp''�� ,,.,. .a...;.. of. � W
pat ] __. . (Signed)__--- "arg_. t ._...._.- ......._.... .._
local Registrar
This P is sufficient for the Re val (and Interment or Created.. a body to any part of the State (so ' local cemetery
or other •ations), sinless removal ' by common carrier, in which • a Transit Permit (VS No. 62) is r /
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