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Brown, Mary Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT W 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. regis Town pDist. No County Village • or City (If city,give street add 41 Name of deceased le, rried, widowed, l Sex ivorced (Ante the word) ate of Death , /� 19�" Age 4 6 Years - �� nths .... ;...... $irthplace r �- t . Cause of Death pp�, Certificate was signed by...--- M.D. Address .,2.tQ . ... Z Place of rial (or Removal) `� f (If body o e‘temporarlIrlie)d,fill in space Ifit� 02— Ceme lU/— / 4 Date of Burial t 19...a. (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 Nu.. ...., , and on the basis the f I HER Y NT A PERMIT to... • .. (Name) (Ad sr the Q to hold to rily and.. . the body. (; .erta - or mso having charg f se) (Inter,remove; erwi of[eta how]) Date.►I •i......:... ... . 19. (Signed).. ✓�L,.... ..� This 'ermit is su .ient for the Removal anal Registrar �r�` (and Interment o remotion) of a body to any part of the State (subject toocal cemetery or other rem...•tions),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required. r,.••po vow "w5:5'., �.cna ; 08 w ° ° * n r,p ^ 0.00 •, yw ^ n- o a. ».... 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