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Gifford, Claude Form VS. 61. NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT err 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, LEEGyIB Y W TTEN IN DURABLE BLACK INK. Dist. No..6. ....e� Registered No. Town County._ .. .. . . 1.-e---2.1.. '. R—S..o • (If city, give street ad Name of deceased ._.. . . . . ok... � .... . . ........ .. Single, married, widowed, ... Se Color.(LF or divorced (write the word ... Date L� Deat .. V 19t Yr Age—.sr� ........Years Months �."....Days Birthplace. 0 Caine of Death.:_ a ���S/� j Certificate was_ signed by... .... a, " f- --- ,...._,..�_..�..,.M.0 Address t �, c Place of Burial (or Removal) dop --eft— (If body is to bet por r. held, i space later) 9-_^Ly` Cemetery....._ 4 .,701_,.14. & t Date of Burial 19. (If body is to be temporarily held, 1 in space later) The Certificate of Death containing the above stated particulars, having been pre ented to me, after careful examina- tion, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have cepted the same for registration, have recorded it in my Local Record with the above stated Registered Number, and o e basis thereof,,I___HEREBY,GRANT A PERMIT to.. .... .. .. Y ......._...._..__..... -q A.r.- t the ,.,- to hold temporarily a % h t t body. (IJ ortaker or person havigg charge of cor ) , remove, or otherwise dispose of [state how]) Dated (� /Y_l 19 S 7 (Signed) " .... . tG/Z Local Registrar 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. •a ..ti iC b •n „c! 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