Sheldon, Curtis Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Villake, 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. gistered No.
/ . Town
Dist. No ,Yi . County...VI 6 Village.... .
C�'���'.fC4f� \'/ (If tits,give street ad less)
Name of deceased . . Y.�.e..... .. (/
Sex'yyyy�� Single, married, widowed,
..2 .Color.L .or divorced (wriie t word). 444. 0.1 Date of each... ..... . °Z at 19..4.3
Age 7 Years.... ././...... ., onths.,...: Da s Bi hplace..
Cause of Death ... Gl
Certificate was signed bye �si3}
Address 6
� - - —� �. .. Y
Place of Bui ial (or Removal)
(If body Is to be temporarily held,fill in space later)
Cemetery.. ..,. .. k , ' • Date of Burial.. 1.5— 19.' .3
(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 ' ration, have recorded it in my Local Record with the above stated Registered
Num , and on the si 4 Y GRANT A PER T
to . .
ame )
the.... .. . . to hold temporal' , and.. ... ... the body.
dertaker or person baviig charge of orpee) - „tip. ,••,or otherwise dispose of[state how])
Dated. 19...V. (Signed) ....
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cre on) of a body to any part of the State (subject 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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