Bennett, Alice Ferns VS. 61. NEW YORK STATE DEPARTMENT OF HEALTH N
OFFICIAL BURIAL (OR REMOVAL) PERMIT
f3 This Permit can be signed only by the Local Regi (Deputy or subregutrar) 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
qq —e Town
Dist. No6..: .S.-..1.County �agE. 4_4.—
�'j�f or.�' (t Ir give t address)
Name of deceased <2' 1/l�i.. �t
Single, married, widowed, �/ ((,
Sex Color -Ur) • or divorced (write the word)..: . .. .Date of DeatLi �C{ 19. /
Age 6.3 Years a M s / Da • ,�$ Birthplace . ---ig uy
Cause of Death /� • S16`c piyl .021.44, f
ry
Certificate was signed by Lo.. .. ...Q:v. .... .. . .... . M.D-
Address . ..
Place of Burial (or Removal) €.(. .. G^w � K<S6�
(If body I.to be temporarily held, fill in apace later) l p• car
Cemetery .r.a 4..4 Date of Burial 04i1 A P 19..Cill
(If body is to be temporarily held. till 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 he 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
Number, and onipte bails they E RJEfl GRANT A PERMIT �// o/
..Z� "" "" Address)
irf the..., if a to hold temporaril an . ...'n . . . the body.
0311 }.r o r+ap hgvtng e5arg f corpse) k star —taco otherwise dlsvwe of[state how))
Dated SG .�: i ( 19...c C (Signed)
Local Registrar
This Permit is sufficient for the R.-moval (and Interment or Cremes n o a ody to any part of the State (subject to local
cemetery or other regulations), unless remove/is by common carrier, in hich case a Transit Permit (VS No. 62) is required.
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