Rowe, James d
Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH F
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t This Permit can be signed only by the Local Registrar (Deputy or subregiatrar) 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.
/ g �,, 1 Town
Dist. No6k?d County...,. ./..44 tttage. ..
.. ... .. ...
f� wit (If city,give str address)
Name of deceased l G!!r .e'"7i1
yy� Single, married, widowed,
Sex. F?`.[.......Color. ....or divorced (write the word) �'L Date eat ../<...1 '-./t e
".._
Age...� Years al Moms � Days Birthplace U./l�Y�s�!�
Cause of Death e,Qhr. x .. �-s
Certificate was signed by a.►. / .04.4"-•--4 M.D.
Address —E 6.cca.. .
Place of Burial (or Removal) �0"7-z .. �... s.., �.. '
(If body is to be temporarily held,fill in c later)
Cemetery ...-, - ., '`'-:^ i ,C,. Date of Burial .. .... . / 19.E..1
(If body is to be temporarily 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 re 'stration, have recorded it in my Local Record with the above stated Registered
Numb r, and on t has' REBY GRANT A PER
to... ���,���the�� t } ��_hj me) dress)
C-C�t to hold tempora/rilnd the body.
�Tadertaker or per wing charge of corpse) !/ nt re ve,or oth rwise dispose of[state how])
Date ,t ii-� i.. 19.44-.�1.. (Signed) v
/ /� 3 Local 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 w ch case a Transit Permit (VS No. 62) is required.
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