Hogan, James / 7 :'' 0
Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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. Registered No 16
Town
Dist. No:,by/ County. * .Ge,-!/Zitz-1--..—,- Villageor City (If city, give street address)
Name of deceased G---744-e----i ,i
Single, rried, wi
ed, -
Sex I, Color ,, or divorced (write tue word). . --7,2-<--<, Date of Death.. A-y n 19Z...
Age Years , 6--- Months -- Days Birthplace
,
Cause of Death „. `-',,,../---:!,.i..-A.-4.-- ---
'Certificate was signed by M.D.
Address
Place of Burial (or Removal) t7 --1-4----4._.
(If body is to be tempo r y held,fill,M_space l‘ater)
Cemetery .V.---C.-c.,•-r.,--- Date of Burial . Z4- /--ii 19. °A.
(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
Numb,, and on Oe_basi ther EBY GRANT A PERMIT e7
,.
( e) (Address)
the to hold temporarily an , the body.
(Undertaker or person having charge of corpse) (I reinove,or 1erwiseQ,Dose of I jte ow])
Dated Wir^-7 ,2;i 19.!-O. (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Stet (subject to local
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