Hammond, Ida l
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,
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.
_ gistered No..............._..---.__.._._
own
Dist. No �j .�Countr— � 4:14 TVi ge..
(If city,give str ddress)
Name of deceased..C- ed.,. +n R.... .
Single, married, widowed, /� ))� �
5ex.�Color. or divorced (write the word)��F.k�,I�S:!?.?�.�"'r,�. Date of ... ..: ...
Age z. Years a� Months.... i Days9... irthpl c 47117
�
Cause of Death
Certificate was signe y . st M.D.
Address . .t.�
l GY
Place of Burial (or Re al) �C
(If body is to be temporaril a .all in a ace I er ----
Cemetery .Date of Burial Q .,.� 19.Z..a
(If body Is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particul rs, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I ha accepted the same for regi ration, have recorded it in my Local R rd with the above stated Registered
Num and o basirher HEREBY GRANT A PERMIT V
to
th z . ) to hold temporaril nd the body.
(tin er k h ag charge of corpse) (In re ove, therwise dispose of[state how])
Date .. . .. 19..4... (Signed) .. .t..... . ........ ... ...
Local Registrar
This Permit is sufficient for the Removal (and Interment or C ati of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier,in ich case a Transit Permit (VS No. 62) is required.
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