Pardo, Catherine „ ?),/
Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
14- 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 CERT,IFATE OF
_..
DEATH, LEGIBLY WRITTEN IN DURABLE SLACK INK. Registered No.. .._...._____...._
Town -y
Dist. No 3 ColAty � Village (A.. ,.}^,2�-
Of City (If eity. •e street address)
Name deceased ���//J
ingle, married, widowed,
Se. olor�-1 r divorced (write the word) (4/ Date of e S 19
Age....... rs Months --. p, gDays--- - , Birthplace.
Cause off Death „/iyL �--E�-
Certificate was sign by... .` ” ,' �—f M.D.
Address .
Place of Burial moval) 1 -e- v
(If body is to be to held, fill in spa r) �j
Cemetery y � Date of Burial... / 19 3 y
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been rented 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 L I Record • the above stated Registered
Noum6 n on the basis t t reof ;HEREBY GRANT A PERM��� �yL�
ACC// '�-��-
the e
LISP to hold temporarily and ( ddreae) the body.
(thdertaker or person baying charge c pre) . (Inter,remppn�(�ar other se dispose of(state howl)
Dated '-t 19... (Signed)... ��L ,'
Z 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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