Silverman, Jennie Fnrm vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
dr 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 CERI5ETAOF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
TDVTIt
Dist. NoSZ.W...County a Village. /--g
•tntccee. t or Cityglee street address)
Name of deceased
Smi, .. .Colorti (writewthe wohrd)-2042""Ciel Date of D
Slagle: , marred
Age 7 Year• /1 Niolis ./ D. s
Ay, 19.51/
_Calm._of Death.. . eseplietitedatt
041044
Certificate was signed by . At, M.O.
Address.
Place of Burial (o Removal)
Of body ls to be temp beld,jr•Aft:,r) if
Cemetery
I; Date of Burial V 19 Se(
A
at body bi to be temporarily held, 11 ,i , later)
The Certificate of Death contain g the above stated particulars, having been presented o me, after careful exami-
nation, the same appearing to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have acce ted the same for gistration, have recorded it in my Local Recc‘r • the ye stated Registered
Number d o the • th f I Y GRANT A PERM
to .
Address)
the to hold temporarily a ... . . . ... ...... ...the body.
Wade ker or peviarbik ehargc of corpse) 11 . r e,o herw.irno o bow))
Dated 19.X1 (Signed)
Local Regtatrat
This Permit sufficient for the Removal (and Interment or .Cramation). of a body to any part ._._of the Ste e (subject to local
. . .
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