Viele, Georgianna Form VS. 61.
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVALt PERMIT
t..,„ :•-•. ,._ ,%, ... -,„. !t
Eir This Permit can be signed only by the Local Registrar (DeParbr Subregfiffrar) 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.--S-‘tO-57 Registered No.
Town
County-n.0 0...n4Q-ArLe,' V44-4frge.
Name of deceased. crr-cvity
le, married, widowed, tiff
A-rtCrr:e"l'CLI 11211-468. (If city, give str address)
Se . ... oloaajlthor divorced (write the word)5.12eYZAP....0 Date of Death
. . . .... . . ..‘?./ 193 7
Age K Years Months ./vg Days .F.w.o.mgeru...0.0.....fri y,
•
Cause of Death
Certificate was signed by 4421.d * W-tvaJr, .....„ M.D
Adciress 1- €L0,4-, h 1,
-Place of"iB urfal (or Removal).771OrtAM.1 9.00 q.AitleY1-i .e.e.)f...il,Ci-r
(If body is to be t rarity held, fill in space r)
Cemetery__ .... Date of Burial 7-....ea,..La I9.3.?
(If body is to be temporarily held, fill i pace 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,
asp d.on the b is th reof I HEREBY GRANT
Ft,,..r...1... '".;,.... ... a.dp PERMIT
) rg---cd.&4 itif .
riketvagetzeil it..7) " 1144".4 ( dress)
the to hold temporaril and ., ,trag4...,,t ....the body.
(Irtake5,or person having charge of serf) (ItleenvCor, erwise dispose of [state how])
Dated........ .wee,a',...l. D.... 1 93 (Signed). e‘.
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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