Getchell, Amilda Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tir This Permit can be signed only by the Local Registrar (Deputy or sulsegistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptanc'h of a CORRECT AND COMPLETE CERTJFIcA OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.'
f�"
To � '
iieet_ <.. O C
Dist. Noll 'r'�[ County ai• •• •• ity,give street address)
i
Name of deceased
I Single, married, widow , 64#
Sex Color or divorced (write the word).. Date of D �� . .' i9`�'( --
Age....�,..r I. Y ars.... ..../....0 Months Dav Birthplace. � :. i-'`
Cause of Death �• 4,41u,
Certificate was signed by .,�) :. 0r-i&O M.f., 1
Addres j. • 7. G�%� . 71!^ -eAti
Place of Buiia or R moval)! ... � ?f-r- • • 5
(If body iiIWAtiempor eld, fill in sp er) Cr � L
Cemet . ... ... ..... .. . . Date of Burial `.. . ` 19. (. ...
(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 Recor with the above stated Registered
Numbe 'y • •n basis ereof NI HE EBY GRANT A PERMIT
t0 (Na ,
the, . . hold tempora ' a the ody.
(Undertake r perso basins charge;*pee) , emove,or oyw isise [st atehow))
Dated...... ... . . c� 19 (Signed) 4��-
cal Registrar
This Permit is sufficient for the Removal (and Inteent or Cremati n) a bod o any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier,in which case a ansit Permit (VS No. 62) is required.
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