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St John, Kathleen F,,rm OS.61. NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT lor This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration Dis rict (Town, Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERIfijAT,E OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered xs �� Dist. No.. 4 C7 County........V e lty � (If city,give street address) Name of deceased ,�xZ(� ;71 ��(j/��, ,}l/1.� . .. Ingle, married, widowed, Sex...}l Colon ,��. ,r--divorced (write the word). /1/1 . Date of D .../9•.. ......19. .1. Age Year-, ,,g Months r Days th lace.�rt� �.ct�1 ,?J.:.. Cause of Death.. ...-'a?d.. Certificate was signed by M.D. Address VII! ' Burial of Burial (or Removal . .. (If body is to be tempy , in s ce later) Cemetery �Y .. . . -.42,.. Date of Burial......:.42/ 19... (If body is to be temporarily held 11 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 Numbe,s d on the b t eof I E E Y GRANT A PERMIT to --, -Alp Ya.14 7i - '.9• ,dress) the I,,Ya! ) to hold temporarily and. !Ar the body. (U. ( aker or perso. ha ing charge o f orpee) nt y�J�.o••,or oth Ise . - of eta M.o• ] Dated �l .. - .r. ..i......19.. /• (Signed) �./ . �� ) Local Reg =tray This Permit is sufficient for the Removal (and Interment or Cremation) o a bo y to any part of the State ( ubject to loca s....a.... .... ..aL e.. ...._..1-a.___� _f__ c_- .. _ _ __ d.0000.0101.11.111"- ,•.w ..;re. �0 n.. p �..ty K 0 p A C"p ', 0..'a ., y w ., < n p^ p• �+..... 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