Garrow, Emery n Ts.61. NEW FORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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. .... V
'Lawn 44
Dist. No,.� �1 County Vi�ge i a` '..4r
or City (If city,give street ddress)
Name of deceased
//�� ingk, d, widowed, � � /S._
Sea Colo or diereed (write the word) .! Date of D t 19V
Age Years.... D Months Z.,, ... ys Birthplace
C use of Death / /
Cert ficate was signed by.... .... M.D.
Address fr". -
Place of Bul ial (or emoval) /.. re,---e- --47---
(If body is to be tempo ' held a ater) �/
Cemetery �-e--e'Date of Burial / 6 19l" 2--
(If body is to be temporarily held, fi 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 Recordco with
hhLthe above stated Registered
Number, d on the as}s-t f I HEREBY GRANT A PERMIT /'&14,4 • '
the .... . .... .. ..... . .... .f... ... . .. to hold temporarily a d ....yeas) the body.
o/
(Unde er or hereon having charge. corpse) ( remove,or othe ise ') se f to how])
Dated .l C..- 7- / 19./2— (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Sta a (subject 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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