Fraser, Mary F rm 1 S.Si. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar 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 CERTI JCATE OF
DEATH, LEGIBLY WRITTEN IN URABLE BLACK INK. _Tewn _sr...144474/ egistered No....
Dist. Nosi2 6 County Village
(If city,give street address)
Name f deceased 2*--1/ 44---0-12.-44-1411.4Y 4
�y Sm e m • , widowed,
Sex. - "�- ololor.Gv�� /"`Sr i orced (wri the word)`" Date o eat ,' . 19 �
Age Co Yea ...f?.. onth ci D ys . ace.
Cause of Death f •Y. .:.. ' * �
Certificate was signed by . . .. ..... M.D.
Address.
1 Place of Bu''al 'or Rem al j .,�...,, a
(If body is to -a.orarily ld,.fill in ep Ii7
Cemetery. r-'�' � 4-4--(A.)-- / Date of Burial... - li 19 44,
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above sta d particulars, having been presented to me, after careful exami-
nation, the same appearing to he COMPLETE, ORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have . cepted the same for registration, have recorded it in my Local ecord with the above stated Registered
Nu .er, aptonitre-b is thereof I HEREBY GRANT A PERMIT 11
or, ( me) (Address) I
the.. to hold temporari y nd �/ the body.
•ertaker or pe o having charge of orpse) (Inter,re or erwi spore of[stet ow])
�p p� ,
Dated...9 ,...1..4�� 19 / (Signed).. * t
I strar
This Permit is sufficient for the Removal (and Interment or Cremation) a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in whit case a Transit Permit (VS No. 62) is required.
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