Brazier, Robert vs. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ttIr 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 CERTA QT OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered IYo_._.Sf.J..... .__
C Town f
Dist. NoS Of County.... Village
r Citg (It city, give street add
Name of deceased �`'
S �i/ `inrie-m widvt�ed/Aa�l:
e t .Color or divorced (write t word) Apnoea(
< Date of De th.
A �6 19��
ge .1►. Year Monthly Days irthglace �`
Cause of Death O'
i
Certificate was signed by,.. ... .. �' ., , M.D.
Address IIVV "��e 7t.'r.
Place of Burial (or Removal) /, ter • yl„y
(If body Is to be temy.��y�,pI 0,Ill apace later
Cemetery ��('l7!(.#...,/ Date of Burial... 4..7 19.9
(If body is to be temporarily held, PH In space later)
The Certificate of Death containing the above stated particulars, having been present to me, after careful exami-
nation, the same appearing to he 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
Nu and on b ' t f I HEREBY GRANT A PERMIT it / ,�!
to ..... /�twn
Address)
the to hold temporarily and.... the body.
(Gad a pen�p pying dwrg corpse) /�/ ,remo e, otb Ise Is• t[state bowl)
Dated... / 1 I9.T� (Signed) {/,r/r/ C•
Local Registrar
This Permit ss sufficient for the Removal (and Interment or Cremation) of a body to any part of a State (subject to local
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