Brady, James Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
g2ir 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 DU LE BLACK INK. Registered No.
��Z/ Tewfl ' /
Dist. No>.0 6/.....County. Ve C�
Or (If city,give street address)
Name of deceased
�/j Si e, married, widowed, L
Sex/� Colo or divorced (write the word) Date of Dfathy 3�19.
Age t ,' Years 7 Months.. .3 e7 "ays Birthplace �/.,4 %Z ,V
C,_use of Death � rt
Certificate was signed by �, 4 M.D.
Address -x,,.-•-s r -
Place of Burial or Removal).. -7--- i. Ifis4-e-14,44.--4447,---
(If body is to be to p ily h s later)
Cemetery - �� e Date of Burial..4 19
(If body is to be temporarily held, 1 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 accept the sam for registr ion, have recorded it in my Local Record with the above Mated Registered
Number, an on th b s yirei5f �Y GRANT A PERMI� /// _oi- M
_ AA/lto U P-f`Gv R�-�^- �`� a.G�c�
the to hold temporarily and real) the body.
(Una•.t0 ker or,••rson having charge of corpse) remove,or oyAsrwise d se of [stet w])
Dated i• Al' 19.V L (Signed) o
Local Registrar
This Per..it is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ('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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