Bennett, Marianne 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, LEGIBLY WRITTEN IN DURABLE BLACK INK.
..---_
Dist. No.s.../-6 J
.r Register No. 37
Town
County . Village ,
�� r City (If city, give street address)
Name of deceased *2-7..1...kPoi---fr-v..R.. % -
Serf ������ � Single, married, wido‘t d, �`
�1"` 'Color �"f,7s or divorced (write the word Date f Death/`�'' 2-Y 19 3 7
Age 'y 3 Ye s ,.) 'Months .7--2" Days Birthplace. .. J,
Cause of lleath pit- _
Certificate was signed by G l.M.K
Address --' ..... . 4- rf
Place of Burial (or Removal) 4-+ l•__'Y e
(If body is to be porarily held, fii.je in space Cemetery .. ,, Date of Burial �.t-/'t 2 4f / 19.37
(If body is to be temporarily Id. 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 the basis thereof I HEREBY GRANT A PERMIT
to
' / fir.,..
(Addr44s)
the ��� to hold temporarily the body.
(U -er or person having charge of cor se) it emove, o ise dispose of [state how])
Dated • �2-- 193 .... (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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