Duchance, Joseph Form VS.6L 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 IN DURABLE BLACK INK. Registered No.
//
Dist. N .(R�,�lxCounty..� TownVillage.. .
or City (If city,give street address
Name of decea . ..
ing e, married, widowed, ������ /
S�IF (..Co� r divorced (write the word e.€4, �/ '�e•Date of �/ 19.�1.`
Age....lr. ,,(r Y rs.AP.. Months..�jf .Bays r Birthplace or.40--
Cause of Death.. ,�L / ... g-+c, r� ....
Certificate was signe .. .� ,.... ... - e p M.D.
Address -. %�-'
Place of Burial (or Removal).. . . .. ... ��g. . .. . ...
(If body is to be temporarily he fill in space
Cemetery.... ..) . Date of Bu ' .2..<3 19,4)
(If body is to be emporarily held,fil in cp ter)
The Certificate of Death con"Hning 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
Nou r, and th sis thereof I HEREBY GRANT A PERMr��
(Name) (Address)
th to hold temporarily and. the body.
Underta r r Verson having charge of corpse) (In re...y� er of a dispose of[state how])
D ... ...A 191A47 (Signed)... ... ... .. , .a/.. ..
ocal Registrar
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 case a Transit Permit (VS No. 62) is required.
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