De Lesle, Julia Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERTIVI' E 9F
DEATH, LEGIBLY WRITTEN IN DUR LE BLACK INK. RRegistered No.....
Town ` `/
Dist. N�� County... Village. C �"7� �Q
s� lty�,, (If city,give street addre
Name f deceased '// �,�2 {��"�''_ '
1GZ"� /%��"" S. , widowed, �� //
Seeeaaa[[t olo or dived write th ord). " Date of t 19 T
Age Y Months.. a2'. Days Birth lac
.. .
C,,use of Death ? 1. - - :
Certificate was signed b .... .. - ��.. .... M.D.
Address ,lam ,
Place of Burial (or Remo , 1)
(If body is to be temporarily h it 1 er !/
Cemetery Date of Burial �-Sr 19T
(If body is to be tem rarily held,fill in ce later)
The Certificate of Death containing the above stated particulars, having been presented to e, after careful exami-
nation, the same appearing to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accep d the same for registra ' , ha recorded it in my Local Record with the above stated Registered
Noumber, a on the basi h GRANT A PERMITCfr -:2y, ,.9 - W.0-6 ,
the to hold temporarily and... 0,' ir:dress) e body.
(Under r r person ng c arg corpse //(yfiter ve,or otherw}y�disn [state )
Dated 19.2.-- (Signed) �/
Local Registrar
This Permit is fficient for the Removal (and Interment or Cremation) of a body to any part of the State (s ject to local
cemetery or other regulations), unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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