Dudley, Edward Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT,
CrThis 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. Regist r No. I O Z
.�6 D l; ,4�L'"' ifl
Dist. No County y �e
�+ ity :2 ity, give street address)
Name of deceased /ryi/ '
Sea/�j� ��Single, married, widowed,
l/'' Color on divorced (write the word).... Date of Dea 19�L
Age Yea4sths pys. Birthplace
Cause of Death GG"" (/
Certificate was signed y.. rL �42**%•,,
•• M.D.
Address ... . . .. .... . .. .... . ��%e+,�y ,Place of Burial r Remo 1). . ....
(If body is to be to,,r. :ri. t space ater [
Cemetery... Date of Burial 4e. 195
/4
(If body is to be temporarily Id, fill in space later)
The Certificate of Dea containing the above stat d particulars, having been prese ted to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have accep the same r egi tr ion, have ecorded it in my Local Record with the ab ��stated/Regis red
o
Number, an e BY RANT A PERMIT
i fr ` 1 G
to
the ( Address)
r to hold temporarily and. .the body.
(Und r or Pe on!ng char orpse) nt e, r othe se di:" of s �+Wl)
Dated 19 ... .. (Signed) fr - ',
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ubject 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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