Stiles, Mary Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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,JCip rt
DEATH, LEGIBLY WRITTEN IN DIG � BLACK INK. Re istered No. i�..77
Dist. No-6-6�� County �7ovvir, ,_�.:1 � i�
b (If city,give street add ss)
or
Name of deceased �41�
redi
z•-•" Sitrgt" married, widowed, �3�
Se "�f Coloiw�%�"' or-4. i eed (write the word) Date of th Z 19 Z
Age ‘0 Years .V Months 1�,��.p.. Days . athplac -�' •
C.:.use of Death C�?.'e#
Certificate was signed' "�'� '� • �,.i. ... M.D.
Address r ! -
Place of Burial (or lc moval). .,! e -77 „ .
(If body is to be tempjJ y held, n space later) p
Cemeteryr ,�.P(c-e Date of Burial 717Q 19, E
(If body is to be t- 4 porarily he flu 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 acc ted the sa e for egist ion, have recorded it in my Local Record with the above stated Registered
Number, on th is EREBY GRANT A PERMIT
dress)
the to hold temporarily a �. the body.
(Ln +�gker or erson h rs charge corpse) temporarily
m ve,or oral isn e o tate bow])
Dated '/�L �0 L9-s4" (Signed) Local.. ... . .... ... .
Registrar
This Permit • sufficient for the Removal (and Interment or Cremation) of a body to any part of the St to (subject 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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