Treehouse, Eugene Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sa 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...._... 1. _
foraccc
Dist. No 5601 County Warr.e.A gxanttpx Gie.Ils...1.a11S:,...N....r.
or City (If city,give street address)
Name of deceased Mrs, Eugene Treehouse
Single, married, widowed, _,
Sex Femaltolor Nillteor divorced (write the word).fi.id .W.0.51- Date of Death Allg Q 19...0..
Age 82 Years 2 Months 11 Days Birthplace St* Johr4g..a Qa.nada
Cause of Death CtrplIiC..AIy.QAfirli.al...dis.Spas0.:7. ..Q...y.r.s....-.a1..ta1.1...s.Cheroais. h gall nsian....
Certificate was signed by Dr.....k7.....Al......F'.r.a.s.i.6r M.D.
Address Ga.4'.no Fall , NA Y..•....
Place of Burial (or Removal) 14.21. 14110
(If body is to be temporarily held,fill in space later)
Cemetery St.., l'i.P21AX1.1.18 Date of Burial Sept 2 1940
(If body is to be temporarily held,Jill in space later)
The Certificate of Death 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 for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to Joseph..-e*.v...R al .Glens...b$1•s`'�idreesj'�Y 4
trarme)the IIXl.Sl rts. ex to hold temporarily and....IAtax the body.
(Undertaker or_person having charge of corpse) r oth se dieno of[state how])
Dated Aug., 3p1 19 40 (Sired) D'3131 ,:ocat 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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