Gaylord, Donald No ` t t DEPARTMENT OF HEALTH OF THE CITY OF NEW a ---.
3) A .
This nit must be heeded to BURIAL-CREMATION-TRANSPORTATION PER T
the Keeper of the Cemetery or
Divinatory by Ore Non! Director ��.
in stuns of the hovel. New York, ---° 194
The Certi di
f Death having 6 furnished to this Department, as required by the Sanitary Code, permission is
hereby given t/ .. . . .i/ of.... .... C
to remove the rmjains oda�. /. ..... . . ... .. Age Yrs Mo Days,
who died at .�..r.✓ .... .. . .... .... Borough ... . ,,,,..._
City of New York �19 ont
-6re9tIIli3R� / I
for Burial* at . .. . ... 0 ... on '..:, .1 .,. ... 1.. 19
I
,. / M.D.
Assk4pt Registrar of RecoB r'
-
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