Jalet, Vanessa Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ur This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Prvnsa.-y 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.___333
Warr en Town
5 601
Dist. No County - Village 44... alateaim...St...rC Larls•••Paa:ls.y.. ge• '
or City (If city,give street address)
Name of deceased Vanessa A. Jalet
Fe malevirhi to Single, married, widowed, married
Sex olor or divorced (write the word) Date of Death DO.P.....3.2., 19.39.
Age 63 Years 4 Months 9 Days Birthplace GlenQ...k'al. .s. . I.....Y.
Cause of Death...Cart.is>zma,...o.e...frar.,sh.raid..•iri.th..m.eta.s.tas3.a-.1...yr....
Certificate was signed by Dr......Ha.rry....De.pan. M.D.
Address GlCnS...F.al . .s...N...I.
Place of Burial (or Removal).. eZ.t...Ga..P.SxS...FallZ.a...NA....Y..
(If body is to be temporarily held,fill in space later)
Cemetery St . Alphonsus Cemetery Date of Burial Deo, lg., 19.9..
(If body 1s 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 Loren W. Singletion .G :: o...FAll.a.....W..•...X.
Und e r t aii a(Name) (Address)
the to hold temporar' ��0 y _-! the body.
(Undertaker.or p:rso having charge of corpse) `I f e,or othe • -of(state how])
Dated 133 19i? ... (Signed ,..�/ �/ -0°'
Local Regis.
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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