Elnis, Anna Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERTIFI!), 'F�OF
DEATH, LEGIBLY WRITTEN IN DU BLACK INK. Registered No. / f
Dist. Noc6Ql....County.... .. .... Vila -..-- At
a '/1
ity (If city,give street address)
Name of deceased •
/QD Single, married, widowed, • •
Sep .Color. or divorced (write the word) Date of ath. a 19.Xt-
Age Years. Month 2- 1- Days irthpl�ce
C..use of Death ly
Certificate was signed b .. _..40-^--, M.D.
Address , mil.
Place of Burial (or oval).. .. ......T
(If body is to be temp hel fily�space later)
Cemetery � ,eC. Date of Burial Q 10"
(If body is to be temporarily held,till In space later)
The Certificate of Death containing the above stated rticulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CO RECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for egistratio h e d it in my Local Record with the above stated Registeredis
Number, an d the ba • reo H A PERMIT AL, , - ,4g._,d c;,.I✓6
to
the to hold temporarily a Te.-_,.. the body.
(Linde r or perk in charge o corpse) (In m e,or se i. .:- of-4si 1,w])
Dated 19.yt�.�..Z (Signed) ..
Lo al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ( bject to local
cemetery or other regulations), unless removal is by common carrier,in which case a Transit Permit (VS No. 62) ' required.
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