Wood, Margaret NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
I; »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.
Dist. No..... ,1. Registered No
/� — Town
County _. _.. . ....Ze•,/ Vil sage
ar ..• vi../2deny 'arg-gf city. give street address)
i
Name9t deceased «. _1 «.«...»»«_...««..........«.............».._«..»............«._..
Single, inatctied, widowed, v r'
Se k; .. 'olor r divot ed (write the word)............. Date o Deat ''. 19. . i.
Age 6...6.` ..Years 2 :Months ..-4,'5 Days../.&- irthplace «._...... ..
Cause of Death
Certificate was signed by r :s ...»» .»...««.M.D.
. .. ... . ..
Address �... . .i..... ,t.. .. � _..«»»..«.....»._.».....
Place of Bur' I (or Removal) .,,st �.�G�►`7et /L.a_ge
(If body is to a porati{y heldy tn�apac la •
Cemetery.... .. s. t.4 (1..� e[r{,1.. Date of P,urial.d 7 19.43!
(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 examina-
tion, 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,
an the basis the eof I E EBY RANT A PERMIT
toir ci / - )(--4-4-"e61.471 4..... ................
-( ame) T72 ( eu) - .�1�
the rl...... .. .. ... .... .:t.e..4'' to hold temporarily and --Z- «...».... «»...«««the body.
( phaving charge �`
rp (Inter, remove, or o erw• dispose of [s how])
Dated... ertak or aon of9 .Ll (Signed) ... ,c.t.. .1,. ». «s,....::..t..r.'"1L
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any p rt 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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