Fish, Elizabeth Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
vir 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 9_._.__..__.__.__
Dist. No...5601...Count Warr.e11 Town
Y• Village a.S...111.1.11 AA1...S t...s M 6XINI.EA1a.11,,...11t....Y..
or City (If city,give street address)
Name of deceased..fla,z#1be ,h.. ,i.e.... '.1.#I
Femal whiteSingle, married, widowed,
e
Sex olor or divorc d (write the word) wattledJa31s Date of Death Il s 19 39
Age...461 Years 7 Months 9 Days Birthplace G: •.0 41...rI1, .1.04...141.....:Ya
Cause of Death..Qa.r.Q.tXICala...Qt tra.1133T.Q.r 0co1on Id%II metastasis to liver-2 years
Certificate was signed by....Dr... a sse...S,....Parker VI 14 -
tkiress�.._ filtiriirr llls a S. Y. .
Place :.f Burial (or Removal) .e.exiablx.y.,..I+1.A...Y..
(If body is to be temporarily held,fill in space later)
Cemetery $ .....,Al,plaQ ue. .C.enieterY Date of Burial Jan. 142 19.3.9..
(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 Sa rard..T.....P.atter lextI3..Ealle..a... 4... .e
(Name) (Address)
the tindar.taskar to hold tempora • :,er the body.
(Undertaker or person having charge of corpse) move,or dispose of[state howl)
Dated t7 .7 ,.....a.3.. 19..39. (Signed .. ...
Local Regi rar
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 sego: tions),unless rentsval is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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