Silverman, Harry Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
. OFFICIAL BURIAL (OR REMOVAL) PERMIT
ur 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. Registered No. /.2
Team
Dist. No. 6 de..County ✓,�. G2-- e. ......................Village Z.R. .. a,.
CT C1t ' (If city, give. tregt address)
y
Name of deceased .- �iy4 P r
�ii
MA6ngle, married. widowed,Sex. .. ..... . ... :.Colo divorced (write the wor ' ....Date of D- ... . .r.Ca l...Cc��...19X
Age 17// Ye,. . / Months........ .- Days Birthplace.. .... .. .... ..
Cause of Death Y G� . . .. , ...
Certificate was signed by .c .. ... " • M.D.
Address - ,2„
Place of Buria (or Removal).
(If body 1s to be p rily held,fill space later) • /
Cemetery... .. ... .. . Date of Burial.... - 0 1954
(If body is to be temporarily held, all 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 ac epw 'd the same for registra ,n, have recorded it in my Local Record with the above stated Registered
Number, .• : on the x si: h= eof I `~ REBY G' • NT A PERMIT %----e‘
to / or
(Na .•, / i
the Air, / of / ,- Address)
... • to hold tempor ' v and ... .. . .. the body.
(IIndeir .g:r.on i.x ing charge f pee) r, or oth rwi snow of [sta how])
Dated 0...19. > (Signed)... t...
egistrar
This 'ermit is sufficient for the Removal (and Interment or Cremation) o ody any part of the State (subject to local
cemetery or other regulations).unless removal is by commnn carrier_ ;., ..,h;..l, .a... . T. .;I Po.,,.;+ (VS N. R91 ;. .....,..o.l
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