Blinn, Ida Perm VS.et. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fr 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. .3
'y� Registered No.._...___.__.—
Dist. No .6.Cou ty /� V Tillage. �� )°. 71
'... ..A_C:.y (If city,glee street address)
Name of deceased....
Single, married, widowed /,/ '
Sex ester r divorced (wrjte the word) Date of T�Satha ... .f� 19...',r.�.0
Age a Y s...... the 6 Days 9 Birthplace.. G/�
Cause of Death....... .... .. ... . .. .. ... .... . . . ..... .. f
Certificate was signed by .. M.D.i.. • 7
Address .. . . . .... . '7.....
Place of Bu i (or Removal).. �. . . . . �V . . y
(It body Is to enporarili�}�iely ale in later) _ __
Cemetery 'Zl.�f.Gt�r:_.•B.IF- Date of Burial.... Zit!: .*19. 4
of body Is be temporarily held, all 10 space later)
The Certificate of Death containing the aboveistated particulars, having been presented t me, after careful exami-
nation, the same appearing to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have accepted the same for registration, have recorded it in my L Record with the above stated Registered
Num an on basi th reef I HEREBY GRANT A PERM
, //'' (Name) - (Address)
the.... . 4c!A to hold temporaril nd he body.
(Q key or person having charge of corpse) (Inter,n eve,or erwls 'disaose of(state 666ow))
Dated ":" ./...d,. 19.:r ! (Signed).
Registrar
This Permit a sufficient for the Removal (and Interment or Cremation) a body to any part of the State (subject to local
etery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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