Witherell, Nathaniel I ..,a „- 61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
N 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 CERTI OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. q�y. / Registyerredd Noo.._
Dist. (...Counts R�!NieG tVill TheinE ...0.../ �!1 . -a��rsit2a/"
(It city give street address)
Name of deceased ra*grt�.Kl.C.ef.RG.. ....ty. .e$.,�,GGu
le, married, widowed, ..�� /�
Sex. . olor.t?iff .. . . 'orced (write the word)I�l�1...42.0CadcC4ate of .. 'AY 19.y./
Age Years. 3 Months it? Da;s Birthplace . .
Cause of Death.... ... . .. • d � �.�.,', ) a
Certificate was signed by '. . .../.try �.. / y� M.D.
Address . .... •
Place of Burial (or Removal).... ..... . nN
(It body La ��(�yyy°ra�_�ttlyy�beld,yy�� pace later) /
Cebody �'enormity l all I . ' Date of Burial.... .. /� 19.
91
(It body Y pporerfly held, all In space later) ,
The Cent e of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to he 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
Numb don thep 'a thet�° 1 REBY GRANT A PERMIT SQ
to ../�llldK .K�+...J" �,4�a r'""'�rfil4d.... .:. ..
,,��rryy..e) / - ) ddnss)
the .l :a..:GeQ/!!�/�/ to hold temporar' and a body.
(Ua a or person ydyecharge of r ) oter.remov ,or othy�Ise a state how
Dated.... .. . • ,�.J 19 � (Signed)..... f ....... r%r 2XrA A
al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) a bod o any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a T anait Permit (VS No. 62) is required.
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