Pardo, James NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tlillr 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. 3,3--Z / Registered No.
Town
County "illage
or City (If city. give street address)
Name of deceased ..
f/f S mgle; married, widowed, �/�/f -` _ ,
Sex/.. r.��!� .or divorced (write the word)... Ver- a's'' / Dat thM ,� .193,F
Age 7? Y 3 'Months l�ia Days, Birth>lace. .. .... . ., ,,,,_,,,,,,,.,,„,,,,yf„„,�•
Cause of Death L -�o � G.t�.�
Certificate was signe b a.. ........._....._.M.D.
Address 7
Place of Burial (or Removal) ti � 1 � (�•+_ , f
(If body is to be temporarily held, fill in space later) �j
Cemetery Date of Burial/�/ Z 7 19,3
(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,
andpthe basis thereof HE BY GRANT A PERMIT E(27t .—
to
Neale) ddress)
the to hold temporarily and , !7 the body.
maker or person h ing charge of corpse
Dated. l/ t 19. . (Inte ve, or otherw'se dispose of Estate howl)
CI_....... (Signed)..... .Cts,.,_.,.. _..
Local Registrar
This Permit is sufficient for the Removal (and Interment.or Cremation) 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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