Seaman, Hyman NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fillir 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. s.5^6 0I Registers No e
-Town
County Gz �.l 1E.-€14-44-e—d-X-(
-tttrage 3,// 6£Clty (If city, give street ddtws)
Name of deceased . ...k-,Gi�i.../ �O%/�I/-h ��� QUSingle, married, widowed, �.
Sex....,r (/./. Color � ..or divorced (write he word) Date o Death �Q^19..,, .7
Age 7 6 Y s LL7 .:Months ,G1 Days /0� 413irthplace.. ...._...._ _.. . .y
Cause of Death .} W { '
Certificate was signs y • I= . ... - ............ .M.D
Address
Place of Burial (or Rem(. ) ... .. . ,(/
(If body is to be temporarily held, , s• ce later) - /
Cemetery Date of urial... .. ... /V 193?.
(If body is to be temporarily fill in space later)
The Certificate of D:- • 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,
:doZoTE
RMIT & eet
• V
the. / ..L/ to hold temporal-. and ..........._..._the body.
( milt o rson ha ing c a f tory e remove, o o etwi of [ante ow))
Dated.. lC) 19...3 (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment.or Cremation) a b to any of the State (subject to local cemetery
or other regulations), unless removal is by common carrier, in which case a Transit Permit S No. 62) is required.
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