Huntington, Lloyd Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed only by the Local R. gist.rar (Deputy or subregistrar) of the Primary Registration District (Town,
Villag= or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATO, LEGIBLY WRITTEN IN DURABLE BLACK INK.
jj k Registered No.
Dist, i\Tr+ .1.. ,...County COVillage..Ia �Q-l�oaSl. .t✓ln.� c
C�CQ.JW.!Se.!\A...
('� (If city, gi a street address)
Name of deceased ate.. .... . . k P..... . .... . . .\. Orvi.
\ �� Single, marri , widowed,
Sex.-/AS.. . Color. .... divorced ; v to tine word)VNA., , Date of D ath .... Q 19..tk
Age..,...l.I1r Years 7 Months X b DaysBirthplace • �1,.v
Cause of Death T �c. �'. ,,, .-.....K.,..
Certificate was signed by .. . A:� : � k... M.D.
ck.u.) , .itt, A ,
Place of P,ur al (or Removal) 8.,r.t.lf ..-.....1.L '. k
(If body is to be temporarily hpgid,fill in space I ter)
Cemetery 1' . .A.,....U. Date of Burial 14A- 9- 19...4.4
(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 registration, have recorded it in my Local Record with the above stated Registered
Num er, and on the basis hereof I HEREBY GRANT A PERMIT �-p� "
to r . .....°::�..a. .�'A-1A- -A- �a , A C-014 . Vs cA I
(Name) I� ++��� . (Address)
the WA,; .ah.I to hold temporarily and ie tJL e body.
7n r ker or person having charge of corpse) (Inter,re ove,orrothen ispose of[state how])
Dated.... . 1,, 19..!i.I (Signed) C ...C!..4.. fiA.A.. .r
Local Registrar
This :?'emit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or Taher regulations), unless sir l is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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