Lynes, John Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar 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 CERTJFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. ... .0_
�J� Ts
Dist. No S,7.. ,6 County it-
, ....Village t,l 7 4-1c. .. 'j .
C/(/ g, y (If eltr. address)
Name of deceased . . ..
Sexhy "" ��.� Single, married, w owed,
i..(L.Srr.Color ... .. divorced (w�'ite the word) Alr/t'e �Q Date o th.. /1..(0." 2 ......1944v
Age Y s MQQ� 1 Days Birthplace.:" .. ! » r .1....
Cause of Death..... ... ... . . �.} .. . .. .. —
Certificate was signed by ! . ........ . \1.D.
Address .... . . .. . '....
Place of B (or Rem al)�.e tR 4� GAS r�Xl !
(If body is to moorarlly Id,BB toe • ter) �/
Cemetery —eteeti....C.,.... Date of Burial .. . .. . Z S 19 TU
(If body L to be temporarily held, fill in space later)
The Certificate of Death containing the above stat 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 Lo Record with the above stated Registered
Nu on e ' t reof I HEREBY GRANT A PERM! /`
r
IName) (Address)
the.... ... S i to hold temporaril nd... ..:. .the body.
ter or re a charge�of corpse) (Inter,rgysye,or o dteoose of Istat howl)
ci Sri ��( � '
Dated. ... . .. .. y.....19... (Signed). `f
al 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 remand is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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