Hovey, Cornelia Form VS. 61.
NEW YORK STATE DEPARTMENT OF HEALTH ; % 't
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Mr 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, LECyI,$I,.Y WIN IN DURABLE BLACK INK.
Dist. No. .. 44.. ...... Registe No.
Town
County
(If city, give street address)
Name of deceased 24,w34...e.„4.4.., .
_ Ig1e, married, widowed;
Se A to iivorced (write t ,word) aR )ate o Death...rA // .19..3 f
Age 0J iYears I( Mon s Days Bir plat ..Alt& s/I �.I
Cause of Death . 1
Certificate was signed by .( tevo,. ....... .. M.D
Address
Place of Burial (or Removal)
(If body is to be temporarily held, fill in c lategr ' / •
Cemetery �/� Date of Burial .. l y 19
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been presented ) me, after careful examina-
tion, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have cepted the .me for registration, have recorded it in my Local Record with the above stated Registered Number,
and on he er H BY GRANT A PERMIT ��
to a -�� "S�FL
/��� (Na ... ( )
the .mil6641 ... .. to hold temporarily and the body.
(Lin tak or per ving charge of co ) In , or otherwise spose of [state Low])
Dated l t..1 19 (Signed) .
Local egtstrar
This Pe t is sufficient for the Removal (and Interment.or Cremation o a y to any part of the State (subject to local cemetery
or other reg tions), unless removal is by common carrier, in which case a Tr resit Permit (VS No. 62) is required.
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