Bierman, Harry Form VS.Cl. 10 21-37•25.0M(17-5481))
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
aW 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. Registered No..z 4,. _..._.
Town
Dist. No5601 County Waxr.= Village...G1en.s..Fa1.1•s.•• iospi•te1
or City (If city, gives t address)
Name of deceased Harr.y...Blarman
„ Single, married,Sex Male Color Whiteor divorced (write the widowed,
d)...married. Date of Deah..AUl&....1.} 1Sea..
Age °° Years 6 Months 10 Days Birthplace Russia
Cause of Death Peri rectal al2sCel,S,g-.1.0...day.s...Gana....Taxamiaid.O...d.ays
Certificate was signed by D�'.e....N.n...L...1'.>'.&ster M.D
jo
Address G�a zls...Falls,...N....Y.
Place of Burial (or Removal) West Gaols. Eallm, NA. Y.
(If body is to be temporarily d al ace later)
Cemetery Jem 1s cemetery
17 ( tcr.y Date of Burial .A ig.....2y 19 38
(If Dimly le to be temporarily held, dll in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, 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 Loren..::i.....Single.tan alens...Ealls.s...IL_.Y..
(Name) (Address)
the Undertaker to hold tempor • Inter the body.
(undertaker or person having charge of corpse) ore,or otherw se of[state how])
Dated ABP,.r....2.., 19....38 (Signed) y t+t Z' t
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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