Loudon, Delia Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
r 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 D RABLE BLACK INK. istered No.
/,( f� . . ,(-4� / l„ Town
Dist. No.. �/ Coun ViHagt
(If city,give street )
Name of eceased.... c
// Single, married, widowed, // 7��nn
Sex.. ....: .Color.<4 , or divorced (write the word),& C���:IGC�Dat Dea _iv,�l.. . ... 19.�f
Age 0 Years 7 Ionths a — Birthplace 46 �� 7.r FL
Cause of Death - u:
Certificate was signed by li M.D.
Address sit.
Place of Burial (or Remov }}
(If body is to be temporarily held fi i�epace la r)
Cemetery 0-4:x1.,.Date of Burial `J... .... .... ... .....:. 19 �.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 e, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have_accepted th :same for r ' tration, have recorded it in my Lo ,Reco d with the above stated Registered
l it Num , and o e bavyt I HEREBY GRANT A PERMIT t
to off � C
ddress)
th to hold temporaril a the body.
("pier or :raving char t'off corpse) ante a ove, r therwise disn a of[state how])
Dated c 1 19..r�`.. / (Signed) .... . .. .g..
Local Registrar
This Permit it sufficient for the Removal (and Interment or Crema' n) of a body to any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in hick case a Transit Permit (VS No. 62) is required.
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