Arthur, Mary Form V8.(IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t ' 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 1N DURABLE BLACK INK. Registered No
Dist. No ate Tetorr
s �/// Count):7Y �414ttge St4:.*tearr....
� � or City (If City,terve at t addrea
Name of deceased.... . . ...de C,?!lr2-
Sex2�t ingle, married, widowed, a
ea24.Color . ...or divorced (write the word)12.; /:GIa Date of each,-A.flfraar.�idd.r24...19..
Age....Z5l. Years l Months Ire D s irt,hplace . � 1.�� �
Cause of Death. . .. e .. .•
.q aeiaCs ..tm4�K6.4.. e.c... ..fatit.?/.y.
Certificate was sig by... W. M.D.
Address ,..aree-se-C t.a yy'
Place of Burial (or Removal). i ,,2 cA.-x.L( •#Ay (..c.g. r
(If body is to befeei paorartly held�.A�)xfl'f'ewtt later
Cemetery...LC.,.cC ze, y Liles Date of Burial.... .e`tl._..n.?„ 19. 0
(If body is to be temporarily held, an In apace later)
The Certificate of Death containing the above sta ed particulars, having been pres nted 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
Numb and on a baDu thyy I BER�Sy) GRANT A PERMIT �jq �r /�,
to.... . 5 ....�KL .ciaj/...-e C rt.V....QL�ee S ...0lath 7-
(Name) (Address).
the to hold temporarily and the body.
(Undertaker or person having charge of corpse) r,remove.o se of(state how])
Dated.... 4oxn6tca.1.a,37..19..$id (Signed) Local
_
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 ease • Transit Permit (VS No. 62) is required.
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