Parker, Fannie Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tir This Permit can be signed only by the Local Registrar (Deputy or suhregistrar) 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.._4 w.A..r_.._
Town
Dist. No 3 County..141. 44 -.4e-, W}1'age . .. .
.,� (It city,give street address)
Name of deceased...g 4.4.E P(• GA
Si..glc, ni...kd, widowed, i'
Sex...f Color 14.J or 4iv reed (write the word) ul Date of e th 3 19 4"
Age 6 ,mil Y are, ,3 ...... ....Mon s /L Days Birthplaces:.
Cause of Death... . .
Certificate was signed'by. ,... . .,....n ........ .. .. . M.D.
Address 1'1.at„ice 4
Place of Burial (or Removal)
(If body is to ile, porn ly held,8lllipreapace late /
Cemetery... ... Date of Burial.�� ..la 1934,
(If body is to be tempora y 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
N ri d n "9 his' thereof I HEREBY GRANT A PERMIT
IO
(Name) 1.44...4
_ (e tees)
the . . to hold temporarily and the body.
( dertaker or person aving charge of corpse) (Inter,rem ,or otherwise dispose of[state how])
Dated.. �l�-�,....3 — 19.`l�/.. (Signed)...6/ ,:... . .. .
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pnrt of the State (subject to local
cemetery or other regulations),unless removed is by common carrier,in which case a Transit Permit-(VS No. 62) is required.
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