Reed, Charles rum Va. on. 0-10-2,-1V,VVu tl/•\16J,
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gir 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.
,5 6 0/ Registered No.....76
Dist. No. �/
Town 3 3 2 ' , . 6. * .. �f q
County `— Village ,� /
Or City (If city, give street address)
Name of deceased re
- .........
/y Single, n arried, widowed, 3�
Sex Colotil or diivorJvd (write the word) Date o Death / 19....
Age Sr Years. \ onths z Y Days Birthplace y,
_cause of Death
Certificate was signed by M.D.
Address �,,/ ,, p il-- �jPlace of Burial or Removal) /f' ;�'`�'�"� "
(If body is to bet ra ' eld, in space later)
Cemetery Date of Burial Z 3i 19.2
(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 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 t basis they f I R_EBY GRANT A PERMIT /�
to
e ddress)
the to hold tempura i_ the body.
( ndertaker or petzion having charge of cQ - ) ( , remove, or of rwise dispose of I state how])
I)atod ,1 19 5 7 (Signed) ... .... --
Local Registrar
This 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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