Bazinet, Caroline Form VS.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Dr 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.253.._._._.__
�601 Town
Dist. No. B[ ....County Warren Village..?$ ...ga.et1.. .t....,.GleD1.s...F.a1.l.s..,N...Y..
or City (If city,give street address)
Name of deceased Caroline Bazinet
Single, married, widowed,
Sex FQX0A1. olor....Iyhiteor divorced (write the word) single. Date of Death ,Sep.t.,...7 , 19...58
Age 74 Years 2 Months 4. Days Birthplace....ShePa►ine/ n, PA,. Oaltad.
Cause of Death Cerebral bI� EmboliR17.1.4.,,des,;chr.......erardio.Y.as.cul.ar.•.d3,$6fase-14•••day
Certificate was signed by Dr. Harry Depan M.D.
Address GIemS...k'a.l.s.,..�? Y..
Place of Burial (or Removal) i'.e.s C...zle.IIls...F.alls.,..1T.....Y...
(If body is to be temporarily held,fill in space later)
Cemetery ......UPhOD. US...C.em.e.tery Date of Burial Sept. i , 19...5.8
(If body is to be temporarily held,fill 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 Lionel J t Boiy,n
(Name) �1i6ne...F&l1(Adrir�ess) y•
the Undertaker to hold tempura ' t?.r the body.
(Undertaker or person having charge of corpse) remov o dispose of[state bow])
Dated SQpI.e.tebr...&., 19.38.. (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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