Ginsburg, Isaac .,.../A-AL-rs.61. NEW YORK STATE DEPARTMENT OF HEALTH .__
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sir 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
jNo.....1.4_!
.
Town �!l.. jj��
Dist.-No. `hl .County.,tt.t,�• 1 �. Village...(: :::;e0„2.
Kr-eh_ �fff�y///
or Ci (If city,give street address
Name of deceased..J.`a.,(.1- ..
-E. A Single, married, widowed,
.G' i . 19' ..
Sep., .�•' `olork .t..,....or divorced (write the word) .. Date of Death.. . . :( ••• •••• ••
Age....e. ,..Years -2-A,.... nths =...g7 D Bi aee
Cause of Death eC.-:-
Certificate was signed by . . .... .... . . M.D.
Address .. ..KG ..`'.
r
_ w Burior—ffernoval " ... ... ... ... .. . . `" �� r..... .... ..
body Is to be te_myorarily�held,�:' space 1 ) t.
fv.,� 1, . ;I.�� -.. .. ate of Burial . .ram: 1 M 191 'f—`
Cemetery G��r'�
(If body is to be temporarily held,fill in space later)
The Certificate of Death cowl wining 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
Nu , and on the basis thereof I HEREBY GRANT A PERMI f ., � .
by / t2�e .. ... .. ....,.R
(Name) (Address)
the // to hold temporal' d ..... the body.
(II r or person vtnr charge o corpse) fTn , o�o se disc se o![state how])
Dated ` ����i V 19.q`, (Signed) . . . .... ...(.•r. . ..:.. .. y
.. oral Res trar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pa-t 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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