Akins, Helen Form VS.eL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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. Registered No. P_._.___.....___.
Town
Dist. No. Q1- County WaZro.A. Village Glen.a...Ealla..Easpital
v �A /� „ or City (If city,give street address)
Name of deceased.... i 1.0fl...tia...,Akj j.a
Single, married, widowed,
Sexi.ernaleColor..Whlta.or divorc (i (write the word) $ido.w.ed Date of Death Z.an....14-, 19...39
Age YearUhronie ,Months. iris-6 Days Chr.BNephritis-6lm ss�Z,�t1ls.,...N....Y...
Cause of Death r
Certificate was signed by Pr...... R0,.D,.....Shields n,
�.�"--..?.du ess d
.11]..ens. .F./1.1.1.a,...N....Y..
Place .f Burial (or Removal) Wg1 .1 (*.LII , ... ..911.6.1...Di.•... ,.
(If body is to be temporary held,1111 in space later)
Cemetery Wft§t gl.ext`..F.a1.1.6...Q.enze.ter.y Date of Burial Jan/..17.., 19..32
(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 exami-
nation, 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, and on the basis thereof I HEREBY GRANT A PERMIT
to ..S,...T.,. $a t►i8rName> .rGlens Fa ll s(AddNre..)Ys
the Undertaken to hold tempora ' e.T.. the body.
(Undertaker or p .on baalAccbarge of corpse) v ,or oth o.e of[state how])
Dated. d aa=nl.• 1 o , 1 y sy 19 (Sign
Local Registrar
This Permit is snffstient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regusr bons),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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