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Vaughn, William NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT 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, LEG LY RIITTTEN IN DURABLE BLACK INK. �.�, Dist. No•. ...� /� Registered No. � 1 - 77,4"e'.-aell-•••o , /County... ' — r .c .r. Co • a a `• (If city, give street address) 77. Name of decease 7reC.0",............�jSingle, married, widowed, Sep[/...[.. Ler. Colo ivoreed (write the word' Date of Death. .7(. .619..al Age /7 Year ..�\.** / ysBirthplace Cause of Death .—..rc.....:�..._: ,._.:._., ... ,,. .. _...._.............. ._.... Certificate was signed by.. .. . ... ao-wirtmr_z".M.D. Address Place of Burial moval) (If body is to bet eld,•fill in space t�� Cemetery ^�—'Ks..e. Date of Bttt•ial... _,19 e 7 (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 caref 1 examina- tion, the same appearing to be COMPLETE, CORRECT. ANI) SATISFACTORY AS REQUIRED BY LAW, I ha - accepted the same for registration, have recorded it in my Local Record with the above s Registered Number, and411?the basis there f I .. iRt:r ANTS A PERMIT �i�o� p/V Xel 4 �y , t.. -- Name) ( dress) the �...:� 4r- to hold temp ril l the body. ( nd rtaker or person having arge of corp•st) ter re therwis f [state howl) Dated ?/a 19,37 (Signed) '4..'..'t.•,.,e,C. _.. 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 or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. --^ •'� . 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