Mason, Ella NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
bbr 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. -6O/.. . .. Registered No.3.? y
�j� ta 1 Town
County...__..fra'z- ,,,�_._...._._.__._. Village ant_-...-.rc_.f..-.-------___...
//,,��''QQ//JJ `-Or( Il)' (If city. sere street addrsn)
Name of deceased._.__e;3cGtCF _ . !`' 'Y! -._..__....._........_............. _ ..._.....
--/ 'I�N Single. m pied, widowed,
Sex .Color_[ Lr r divorced (writ e the word)` - Date u• Death.. . . _ . • q maa 2-_t..__1937
Age__t..�._..—_._Ye��jjar��• .....//..�_...._....\Months 1 O I i ,s L Birthplace.lY t- . . i �./' , -
Cause of Death...>w�ll[[s-east_ at-eo"�`�"c_-41-4"0 ...c Q•
Certificate was signed by-,._...... fiz-In-1/ AA ...__. _._.Itl.l)
Address._ --_. .4 .- if• ''
• /.r__._
Place of Burial Ior Run.,
lif body is w be tempK•he' .r +o a :sic./, /
Cemetery_. ..._..._.. _.__._��"t�"ge.... .....__Date of Burial - -?/ 2 /..._1937
;If hedy ,s so be wmporenly held. later)..__
The Certificate of Death containing the above stated pa culars. having been presented to me. alter careful examina-
•:.m, 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 e basis th reof I EBY GRANT A PERMIT *14 *
Ir
7,2
....to hold ten 1po e body.) nri •
(Under apers
on +ri chaste of Syr I v, or of Rude bowl)
:;a 1 3- ng 0/_--_19„l 7 I Signedl... ... ... .. ..._..__..._. _._.__.__.
(.oral Region/
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local cemeten
or other regulations), unless remoral is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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