Truesdale, Mary Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
vir 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.....
•
�� ' Town _,
Dist. No`� yCounty �iii�t J/
�/)77Lei4-42-4?-42t.
If city,give st t address)
Name of deceased ' '•
:1e, married, widowed, e-3, '
Sean _Color �L divorced w ' the word)rff ,� 9.'�/.( rrt�e .. .�LRt44�•-� Date f eat �. . .
Age 2 y Yea MQnths.... ... Days Birthplace. i i..
Cause of Death
Certificate was signed by ... . .. . ..N.:C M.D.
Address `�`'fw'•r•`!1.
Place of rial (or Removal).... .., �.}'1 •
(If body is t e temporarily he,1 All 1 ice later)
Cemetery. Date of urial. ,,r 19..`i/
(If body is to be tempor ly held,All in space later)
The Certificate of eath containing the above stated particulars, having been presented to e, 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 L Record with the above stated Registered
Nu a s' ereof I HEREBY GRANT A PERto
QQ.
(Name) (Address)
the.... to hold temporarily . the body.
( ndertaker or person firing charge�oyyco se) (Inter,remosqe,�,�,�or e
• ..s'ose of state how))
Dated.. . //,. 19...7" (Sired) • /I'I I ' '
r LRegistrar
T is Permit is s cient for the Removal (and Interment or Cremation) oft.ody to any part of the State (subject to local
cemetery or other lations),unless removal is by common carrier, in which c a Transit Permit (VS No. 62) is required.
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