Morse, Curtis Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Er 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. yl Registered No. /./
Dist. No-,1-44Ail County Village
At^city (If city,give street address
Name of deceased
Ingle, married, widowed, -
Sex. Color«fe(77 divorced (write the word). . .. . .Date of Death. `S 195,
Age y° Years 4D ,..Months ai Days Birthplace e
Cause of Death .. . .. ..... / ..
Certificate was signed by •a/- �� M.D.
Address ✓ �..f' -...... .. ��:l..l.......... ..
Place of Burial (or Removal) ...
(If body is to be tem oraril held,fill spa r)
Cemetery.... . .... ate of Burial...14 Y 19!!..
(If body is to be temporar held,fill to space la )
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
Number, an on the basi ther f I HEREBY GRANT A PERMIT
to 7,4,... . .1 If 4. s .� i .-Y,�.4,de
(Address)
the to hold tempora ' and the body.
(Uncle ker or p opt ving charge st corpse) her se se of[eta howl)
Dated 19.. ... (Signed),,,....
/�?42/ Local Registrar
This Permit is sufficient for the Removal (and Interment or Cre a on a o any part of the State (subject to local
cemetery or other revulations).unless removal is by common carrier. in which case a ' ansit Permit (VS No. 62) is required.
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