Murphy, Baby boy Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
X This Pern.iit can be aimed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or Cityj,`i, which th de .otturred after the FILING and acceptance of a CORRECT AND COMPLETE CERT:'ITE OF
DEATH, LEGIBLY WRIt�T ill, ABLE BLACK INK. R gistered o.--� .7
Dist. No �d� County 4-V41age- .... .
Or City (If city, give street t'addr s)
Name o eceased ,. .. ... . .....,ll..l... . y ..
Si gle, marrie'idowed,Sex. . . . .Color..7(), divorced (write the word .. Date of ..:. .,.,.��p l .
Age �/ Ye Zonths.... Q �/f,.,�!,g .. ays � Birthplace. ...
Cause of Death �.. . . . —...
Certificate was signe v. M.D.
Address .. .. .. ... .. . .
Place of Burial ; emova ' .. . .. .... . .. . . %%
(If body is to be •.•. rily pace la er
(S)
Cemetery.. ..I.... Date of Burial -P-e.."• -3- 19.
(If body is to be temporarily h fill in space later)
The Certificate of Deat 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 egistration, have recorded it in my Lo f ' ord with„or'above sta ed Registered
Number on REBY GRANT A PERMIT //
to (I1 ddress) , ?Jr'
the to hold tempora r� ... .. . : the body.
( P or person having charge f corpse) � ny' ~•• e .,erwise dis'ose of[state how])
Dated.. ... . . ....�G� 19.dd (Signed .��:. .. or r 4e
ocal •egistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to a. part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier,in which case a Transit 'ermit (VS No. 62) is required.
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