Lee, Lillian F
Form VS.61. NEW YORK STATE DEPARTENT PERM T HEALTH
OFFICIAL BURIAL (OR REMOVAL) Registration District (Town,
t This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary
Registered CERTIFICATE
or City) in which the death occurred after the FILINGand acceptance of a CORRECT AND COMPLETE CERTIFICATE O
ge, BLACK
DEATH, LEGIBLY WRITTEN IN DURABLETown
a__ietr4Aup,„sa„t4..
give street address)
�� County. • • • f city, g
Dist. No� ..... .... ...... ..............................................
....... ...
S
1.
Name of deceased ..........
th ,(.. ............19. ... •
--��� Ingle, married, widowed, Date of
�...Color.W..Qr divorced (write th wordl•y. ..
A Days
VIIa -••• "
Mo the .... ...
Age..... �......Y ar �.......... .................................................. ...
M.D.
Cause of Death... .................. .......................... ......
Certificate was signe .lw!!� • , .. ................................................
Address •• �..:(.•• ••••••••••
Place of Burial (or,'emoval) � ............19... ....
ace ter) �........ .. ..
(If body is to be temp."' t• held, .. ...................................Date of Burial.. . '
Cemetery •� �� � presented to me, after careful exami-
nation,body is to be temporarily held,fill,,s ace later) REQUIRED BY LAW,
The Certificate of Death non`^fining the above stated R CT, N SATISFACTORY
RYith the above stated Registered
nation, the same appearing foro g COMPLETE, CORRECT,
AND SATISFACTORY AS
same registration, have recorded A PERMIT \ ,,
I have accepted the : thereof I EREBY GRANTYt••� /
r and on "'
Num , . . ..... .... � h body.
.................... .. ..
. . ..... A rasa)
to........ ! .................. ......• to
(Name) [state ho
to hold temporarily an er, ooe,o therwiae .•.,••,
»one of how])
t11e.... . .. ker or person having char o corpse) ... ' h ])
JJ ae 19 (Signed).......... F"" ocai Registrar
Dated..��.. ••x•••�•'�
This Permit is sufficient for the Removal (and Interment or Cremation) of a hotly to any part of the State (subject to local
cemetery or other regulations), unlesr removal it by common carrier,in which case a Transit Permit (VS No. 62) is required.
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