Kautrowitz, Morris NEW YORK STATE DEPARTMENT OF HEALTH •
OFFICIAL BURIAL (OR REMOVAL) PERMIT
iir 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, LEGIBLYBL WRITTEN IN DURABLE BLACK INK.
Dist. No.. ...I n_Q.../ �•�f Registered No........ _ae7l ._...
7, Town �O //
County.--._.LLL/. LCLl�rLCL...._._...._ _Aillage.. 04 ef L1.. ..
or City. l If coy. sin suet address)
Nameo deceased ...._._._.........__.._...._.__.__ .. .. ...... /. .. _ ._......_._.__. �.__..
Single, married. widowed,
Se .a._Color._.. . . or divorced (write the word)..'_. .. .._..._....... )ate t " eath . ._ ._
Age_ /_ .....YC -.._.__.__.L1. \hnyths...._._4_...._Uays Birtthpla. • r_... .... .. ...
— Causemllleath__� eGs�G.. G4usx i%
Certificate was signed by .fir y._.._. .... . ____ � ///�'� ____._......_M.I)
Address.__.___._...._.._......:_/� ._ w t (.{..�.(.<Q. ._-.
Place of Burly(or Removal .... ...Qy a __.._..._._._._.._
(If body is to be.. (. &..-rarity held. fill, space later)
2
Cemetery .. . . _.__._._....._.._._.. . . .Uate a urial.._ r ,_�_.19.0�/
IIf body is to,,,yyyyyy�tmporarily held. fill in spec. Inn)
The Ce to
of Death containing the above stated particulars. having been pry ed to me. alto careful examina-
?ion, th amr appearing to be COMPLETE. CORRECT. AND S,\'I'I S1 :\(' OIt\' AS REQUIRED BY LAW.
I have a pted the same for registration, have recorded it in my Local Record with the above stated Registered Number,
and o e basis thereof I 'ER/r�BY tNT A RMIT /n
lts.) % le-lr" \
the._.._.......... .. ....._.. ... ... .._.... ... ._. ....._.._ _ ... to hold tempura-1 • and ..._ —._the body.
1 n r sr or per hwiyyrr�cbarg. of coag.gy+ . «move. or herwia� Hof�tsas�j�'l)
Dated _. Ile5.//._ 19.... ... (Sigurd _a...._..__J�iae,G.Q--.'�.-`._.___.._._.
Larval Registrar
Thi remit is au tricot for the Removal (and Interment or Cremation) o a to any p of the State (subject to local eemeten
or other regulations), sinless removal is by eemmon carrier, in which eau a Transi Permit ( No. 62) is required.
I
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