Barber, Elmer -
Perm VS.et. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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 CERTIFIC TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE� BLACK INK. Registered No /m
t ( ee- rlet Villa Dist. No.. .. .Q�.County.... ^ C (If address)
}.. Or {Il`�S,l'� ct(Y.Rive street eaddress)Name of deceased
�j� Single, married, widowed, C�yJ
Sex..-CM Colot'�fl..Rle j or divorced (write the wordWeeit r-GKrtig.Date of th... l( %f!...19441
Age 7.oT Year er....Mon ... ....i. D s ' hplac . ... ... `32 •
Cause of Death 3..
Certificate was sign 7:.. a . .. . . . id
Address :
Place of Burials R oval)..l Gin
(It body A to>M orarlt�het•,at —
Cemetery r . Date of urial... .... 19.q1
(If body Is to be temporarily held, d I In apses 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 a ted the same for registra • n, have recorded it in my L Record with thpove stated Regiate
Numb nd on the has' ttlf I GRANT A PERMI e- rt
Ad o)
the to hold temporaril nd ... . th Y.
(U tak or person}�pviog charge o cor se) (In , Inye,or rw se atw (stets bowl)
Dated.... tom`^ 19... (Signed). -
Local Registrar
This Permit is sufficient for the Removal (and Interment or on) of a ody to any part of the State (subject to local
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