Swirsky, Sarah Form VS.61. NEW -YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t2 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......... .............l
c Lai
Dist. No....`5.63Q1..County Warren XIMIrage Glans-lealls ...I�ew..:fork ,
or City (If city,give'ttreet address)
Name qf.,deceased S,AR.AH...SWIRSBY
F,emal ab'hlt Single, married, widowed,
Sex color c or divorced (write the word) trio d Date of Death Jilna...5th 19.4.1..
Age 57 Years Months Days Birthplace....Mola.t.,...Russi.a.
Cause of Death hypertensive eardic vascular, renaldisuse
Certificate was signed by kl#. '.ry.. ulaff Ada.. M.D.
Address 81 lA ' .§....�t� .•.:. 'r ,Hx1,Fi.. ''a111s.,. .NeW..York
Place of Burial (or Removal) `Te.St...Gles...1a11s,...New York
(If body is to be temporrarriily held,fill in space later)
Cemetery JJ l.sill Date of Burial Ju ...5.#,h 19...41
(If body is to be temporarily held,fill 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 be 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
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to , Emmett 11*...grAl esn. Glen,s..FaU g :New...T•arc
(Flame) . (Adatesa)
the Undertaker t to hold temporal-' and 1'tar ant the body.
(Undertaker or person having charge of corpse) er se of, eta ow])
1l aline...5th,...1.94119 (Signed)
'A_ Local Registrar
'his Permit is sufficient for the Removal (and Interfnent or mation) of a body to any part of_the State (subject4A
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