Carter, Joseph I NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr This Permit can be signed only by the Local Registrar (Deputy or subregutrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERT/IFV,F/,]'E OF
DEATH, LEEGIBL/Y WRITTEN IN DU BLACK INK. [/ ']� 'atered No __.._
Dist. No4I0L..County �� o�e 7 , . % �..
Name of deceased a (If city,give street address)
arried, witicf 7R1,
S Color or diverted (write the word)210111444 Date�iy of 150 19 Ci
Age 70 Yea rt �f hs 41 Days ' thplace. �'Y
Cause of Death
Certificate was-signed by ,R, �! T — M.D.
Address a ) '
Place of Burial ( Removal ours... .
(If body Is to be tem ly n ee later)
Cemetery Date of Burial" i 19.W.
(If body la to be temporarily Geld 11 In spate later)
The Certificate of Death ontaining 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 acce ed the same for registration, have recorded it in my Local Recoo with fthe ahoy stated Registered
Nurttber on th a the 1 HEREBY GRANT A PERMIT /��ar I�
to ! .
aareaa)
the to hold temporarily an .. ... the body.
(U rta pe on having clarg""ep corpse) (In en re,or otetwlse d [a owl)
Dated 19.r .. (Signed)
Loral Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State 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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