Johnson, Baby boy rzs7
Form VS.61.. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 'FABLE BLACK INK. egistered No. /7
� Town �.Dist. No.✓64./..County.... Village ,f..�(, c
� cage
. ss)..... .
/ Or Clt (If city, give street address)
Name of deceased
C !N'7t�y�� igle, arried, widow , dSe3J
..... .. olor. norced-(writ ord) ... .. .. Date o,,D ath. , �? 19. . .../
Age.. 4. Da s6 c Birthplac .Ate.. . y� 4Z-
Cause of Death �f r�...Y .'.... , -
Certificate was sig by... .. .. ....1' .... a'......ti* M.D.
Address C
Place of Buria ,s r Removal .. . . . //- iC.?2-A.
(If body Is to be . porarilyl 1 in space lat r)Cemetery .- y/ Date f Burial. . . ...f A 19. :.I
(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 • regi ation, have recorded it in my oval Record with the above stated Registered
Num an• o. i+. has'�*er• . I' HEREBY GRANT A PE
to r
' I 0 d as)
the.. to hold tempor and the/Jody.
(Uniiir aker or person),h y�/Gllarge o corpse) r,re rwi a di a o![state wD
Dated • a- C I 4 '^ 19...41 (Signed).... ,
ocal Registrar
Thrmit is sufficient for the Removal (and Interment or emati o a body any part of the State (subject to local
cemeter r other regulations),unless removal is by common ca , in which case a Tr 'sit Permit (VS No. 62) is required.
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