Ramsey, George Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
VT This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Villa.e, 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.
�,," Town
Dist. NJ'40. /County ��;�ii � l_ , e
or (If city,give rest address)
N ime of deceased
4`rr Sing married, widow ,
Sex. .. ., .. . .Color.�.i r di orced (wri w the ord). „ Date of. ath //' / 2.. .
Age . Years.... ....... Months .0..Q ays " ' thplace.... 1
Cause of Death �..j
Certificate was signed by (1(.� �.. ..M ` ' M.D.
Address (f
Place of Bu,ial (or Removal) _ k
(If body is to be temporarily held, fill I tt /
Cemetery. .... .. . ... .................... .� . G ••..G)V' �Yl;lalWr,I.L. Date of Burial "71 � 19.. .01
(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 he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have accepted the same for r 'stration, have recorded it in my Local Record with the above stated Registered
Number nd on ba thf I HEREBY GRANT A PERMIT case
to (/... `� r`LL 1 ft
ame) y{ .1 ss)
the to hold temporarily and /Wel:L/� e body.
("Aker or p rson aving charge of pee) /J,(Inte re v-e,,-�therwise dispose of[state how])
Dated. . 19..�f. (Signed) .. �(• 4. ./. . .. . .
Local Registrar
This Permit i sufficient for the Removal (and Interment or rem ion o a body
to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, i hich ase a Transit Permit (VS No. 62) is required.
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