Williams, John '
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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 CERTIFI A
DEATH, LEGIBY WRITTEN IN DURABLE BLACK INK. Registered No........, ._-A
Dist. No.Vele/County (9 V°11 n e Saratoga sprtngsz it. .y�
• (If city,give street address)
Name of deceased )...2.A
..r. ..
Single, married, widowed, ^,
Sex... . . . . . Dior divorce (write t�i wor 4� Date o eath
/ 7 19*
Age Y ars
g M s • �,....D s plat . 4Rr».r�. ,
Cause of Death „4~
Certificate was signed by ,lq„..,, 714 D.
Address...
Place of Buri r Removal).. ff
at body is to orartly held, Dace later)
Cemetery .•. .. . . Date of Burial K!�Y e'C' 19
(If body Is to m a o h ,d i eli )
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same a.searing •e COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted . ' f tr io, , : recorded it in my . - ' • f rd with ve tatSd.,Registered
Number, and`' . as' :•', v., 0 'EBY GRANT A PERM
1 •7.
tO
:ted
hold temporari '� the body.
g charge ( n ove, " 'how
;/ 19 (Si• gned) 40...
This Permit is sufr dent for the Removal (and Interment or Cremation) of a •• to • - 0;21` .
cemetery or other regu. dons),unless removal is by common carrier,in which case a Transit Permit •. 62) re;!1
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