Strand, Charles Form vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERTIF CA OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
Dist. No. b /.County... . Town ;C , LT�2� ✓Village
or C (If city,give street address)
Name of deceased ✓-.. •
Single, married, widowed,
Sex �' Color or divorced (write the word).. , Date of De ..?# 19. .2
Age ...11.: Y ars .:..Mon h Days Birthplace i
Cause of Death. .. ' _ ..... .. . ' ..A ,r........ . f. _ _
. ` � . ,
Certificate was signed by ,.... .® v. o u .. . M.D.
Address .>i,'rif.
Place of Burial (or Removal) fi l(If body is to be tempo held,fill 19�p�later)
Cemetery ..Cr.4�� Date of uria7cie--1-4k2,7 19. ai
(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 accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Numb a on th bag)/they H R!'BY ('RANT A PERMIT
to (2. �.C..a...t
am ddress) s,
the to hold temporaril d (A ....., • Abe body.
(Linder or p on ha/t ng charge of corpse) emove o ise s, {statq how
Dated 2 ..19.4/.r (Sighed)
• al Registrar
This Permit is su cient for the Removal (and Interment or Cremation,, a body any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Tr sit Permit (VS No. 62) is required.
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