Kirkpatrick, Baby girl Form V8.6L
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
zr 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 CERTJFJ ATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No..._._(p._.��_._._.._.-
56�1 Town
Dist. No County Warren Village29 Ridge"...`+,►t, :,.... e ...Fall5....N. Y.
or City (It city,give street address)
Name of deceased Baby Girl Kirkpatrick (Stillborn)
e ifl 1 e Single, married, widowed,
Se Color. i to or divorc•ed (write the word) gi ngl a Date of Death..ligkrqb lAt.a 19...v 9
Age -- Years '`— Months -- Days Birthplace Olen* Z.41 .04....Ka... .e.
Cause of Death.$1.r'411zulfrtdop in TAero and pore wrapped...t.1.1.p.Q...A 'Aanci...no.ok,
Certificate was signed by...L• NA .D.9 We12 M.D.
'Address ..1.0.n41. .F..I411.€t a...11.t...T
Place •f Burial (or Removal)....Town of , tc4ueensbn".y, N. Y.
(If body is to be rarlly eld,fill 1 space later)
Cemetery erne View Ce m e c e ry Date of Burial..M .ZQkl lat.. 1939...
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to Har91d...G..:....... ... 221 Glen At ., glcn$ Fall4, N. Y.
undert a (Name) (Address)
the A r to hold tempora ' and inter the body.
(Undertaker or_person having charge of corpse) movy�gt7'ot ( howl)
Dated.... arSaa kat., 19.39... (Signed) ((��,,��//
Local Registrar
This Permit is suf41tient for the Removal (and Interment or Cremation of a b to any part of the State (subject to local
cemetery or other regu..lions),males remteval is by common carrier,in which case ransit Permit (VS No. 62) is required. '
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