Chitty, Louis Form V S.61. 10-21-37-25,000(17-3469)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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...-.1.9.9..._..._.._
Town Dist. No...r5�2Q1...County W . ..eX4 Village G�,9ns `a, �:s f, •;• 3 L �-����:'perl..IA
or City (If city,give street address)
Name of deceased Louis C,l1,rtt ;
Single, married, widowed,
Sex..14A.10 Color Wi1it or divorced (write the word)...Mar'Xied Date of Death.�T.Q.Y. .beX...4 19...3E3
Age 70 Years 9 Months 4 Days Birthplace... '' .7l61?�P.... l.$.t... .r N'
Cause of Death Coronary Thrombosis ( Coronary Sclerosis — Cirrhosis of Liver)
Certificate was signed by Z......Lo.Qxiard..Byxuas M.D.
Address....1 HildP..Q.lk..Z3, C.P.,...J3.LidP..P.11 F.4.1ls.1... e.•... fe
Place of Burial (or Removal) Ton or... Uof ro .L? `y...,...N......Xs
(If body is to be temporarily held,fill in space later)
Cemetery P ne...View Date of Burial NQ.V......el 19..38
(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 Liona. . s..$4 :Y.ill Glexl.a... '.4J1.1iv6...N......I..
(Name) (Address)
the Vigtg.rt.a4e.r to hold tempor,�a�7�'1 Da.ter the body.
( dertaker or person having charge of corpse) / ,remove,or o se dispose of[state how])
Dated A ov t 5 19.. .. (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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