Newcomb, Lydia Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
r' 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_._1i.t
55 // �' lJj Tarr t
Dist. Not 72.4?.County. 4Qi Village. Y ' ' y}1J
F% U (It ally,glre street addressy/
Aramf deceased a-44/a11� . ... .. v
Single, married, widowed, �!
Ser olo / or divorced (wf e word) - �^ ,,'r Date ath ff1 151... !
Age Ye W.. ....r.. Dfonthsir �... Days - BG� � F+-ul! �V�i�t
Cause of Death
Certificate was signed y - ,,. ,... .s�., M.D.
.�?.?..... .. // tY
Address � �. . ... ..... ..
Place of (or cal)
(If la t Lem d, l) a la
Cemete ... . �a. Date of Burial 19 �l
lit body to to be temporarily Odd. dll In spare later)
The Certificate of Death containing the above stated p iculars, having been presented t e, after careful exami-
nation, the same appearing to he COMPLETE, COR CT, AND SATISFACTORY AS REQUIRED BY LAW.
I have accepted th same for registration, Gave recorded it in my L. - Record vaith the above stated Registered
Num�J bs of I HEREBY GRANT A PERM ' / o G
(Name) (Addwe) 7
the.. �' to hold temporaril and..I . .. f the body.
m er or reo lag charge of o pee) ( etas, - dUpow of(state bow])
'FF
Dated FK� � 19...7�f (Signed)
... ........ .�'- ttrgt.trar
This rmit is sufficient for the Removal (and Interment or Cremati 1 of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in wh case a Transit Permit (VS No. 62) is required.
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