Van Vranken, Fannie Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
s2r 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. Regis ered No. ff a
��6'°' /� Town
Dist. No County r/f/ r
Name f deceased or t
(IP y, glue street address)
,. ii/Z/ Single, married, to widowed,h i ,/
Se Color �-"t� or di�+erced (write the word) Date of eath.. l3. 19J�'
Age 6 O Years 6 Months .r. D ys , Birthplace. h..:
Cause of Death et9-14 t� ... .. . .. . :.... ....
Certificate was signed b , .. a� — -- M.D.
Address �r� 4 .. .. 97 ff. — -
Place of Burial (or R moval) T 't'l,..'e
(If body is to be tempo held,fill in space late ) ,?
Cemetery Date of Burial.. X 19 5‘7--
(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 acce d the sa for registration, have recorded it in my Local Record with the above stated Regist red
Number, ' on the b it_____"there,tifitEBY GRANT A PER i�/,:
/.�
to �/ "' ress)
the !/. to hold temporarily and. .. the body.
dertaker or pg�'gon having charge o1 cor e) / nt o or oth ase di of s o+�l)
Dated .l(1 19 51 (Signed) C. .. �`
, Local Registrar
T is Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State psubject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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