La Pointe, Louis `_a NEW YORK STATE DEPARTMENT OF HEALTH
' OFFICIAL BURIAL (OR REMOVAL) PERMIT
UtThis 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 WR/TTEN IN DURABLE BLACK INK.
Oil
Dust No.. --_...Albany Town Registered No.........................._..... .
County_..... ...._._..__AJ.bb.a.n.Y_.._. __.Village___
... r City (tf coy, pee server address
•
.. ,.
Name of deceased... .___..Q_., .. _�a...._ ._ _..___ .___._..._
1/4- �i Single. married, widowed, ,, • �
Se�x__....__- ..Color._..._._._._.-._or divorced (write the word).__._�.."- :.SL._.__._Date - eath_� aS,1d,r: `v _.1 1•
...
Age D_] _.Y s_._._._._‘..._l_..\)oaths...__. _ ._-. Days Birthplace____ o • , 4.01
Cause of Death.. _ ..... att....:
Certificate was signed bra•- Y' pf.D
Address_---- ---- N...___.
Place of Bur. for Rcntocal .. ..............
(If body is to be v,h• h fil m space I rl [�
Cemetery_.__. .... .L.. _Date of Burial _. . .---._.__�_.1
m
(It body a to be temporarily held. fill sn war later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful examina-
tion, the sante appearing to be COMPLETE. CORRECT. AND SATISFACTORY AS REQUIRED BY LAW.
I have accepted the same for registration, have recorded it in my Local R ord with the above stated Registered Number,
and on ereof REBYY GRANT A PERMIT
(Nasty) ... jate (Address)
The....._._._..__._ to hold tem,tn , it ud..._._._._ y.
r— n�d,ero�ker or person hrennt chart, of copssl (Inter.•remove. ortate a d, / lame ) e
l)atto�.cst�(r -V.. .._.._.__..19 - ' . (SIgtntil' . .. ..01.aa/�ll.t_g_ xIw . .....z _. •
—� Local Retina
This Permit is sufficient for the Removal (and Interment or Cremation) Est a y to any ban 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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